In the post-TAVR era, 1-year all-cause mortality for severe aortic stenosis patients decreased to 10.2% from 16.0%, with a hazard ratio of 0.55 (95% CI, 0.47–0.63).
Does management in the post-TAVR era improve 1-year all-cause mortality in patients with severe aortic stenosis compared to the pre-TAVR era?
The introduction of TAVR in Japan was associated with a significant reduction in 1-year all-cause mortality among the overall population of patients with severe aortic stenosis, although heart failure hospitalizations remained unchanged.
Absolute Event Rate: 0% vs 0%
BACKGROUND: The overall impact of the introduction of transcatheter aortic valve replacement (AVR) on the prognosis of the entire population with severe aortic stenosis has not been evaluated. METHODS: We analyzed 2 multicenter registries that consecutively enrolled patients with severe aortic stenosis before and after the introduction of transcatheter AVR in Japan (CURRENT AS CURRENT AS, Contemporary Outcomes After Surgery and Medical Treatment in Patients With Severe Aortic Stenosis Registry-1: 2003–2011; Registry-2: 2018–2020). Data were derived from hospital electronic health records. The primary outcome was 1-year all-cause mortality. Secondary outcomes included hospitalization for heart failure, cardiovascular death, and noncardiovascular death. we Multivariable Cox proportional hazards models were adjusted for age, sex, body mass index, hypertension, current smoking, diabetes on insulin therapy, prior myocardial infarction, prior symptomatic stroke, atrial fibrillation or flutter, aortic or peripheral vascular disease, creatinine level, hemodialysis, anemia, liver cirrhosis (child B or C), malignancy currently under treatment, chronic lung disease (moderate or severe), coronary artery disease, peak aortic jet velocity, any combined moderate or severe valvular disease, and tricuspid regurgitation pressure gradient. RESULTS: A total of 6645 patients (Registry-1: 3448 patients, and Registry-2: 3197 patients) were included. Patients in Registry-2 were older than those in Registry-1 (81.7 versus 77.8 years), and an initial AVR strategy was more frequently selected (49.9% versus 31.3%). The cumulative 1-year incidence and adjusted risk of 1-year all-cause mortality were lower in Registry-2 than in Registry-1 (10.2% versus 16.0%, P <0.001, hazard ratio, 0.55 95% CI, 0.47–0.63). In contrast, the incidence and adjusted risk of hospitalization for heart failure did not differ between Registry-2 and Registry-1 (8.5% versus 9.0%, P =0.66, hazard ratio, 0.88 95% CI, 0.75–1.04). CONCLUSIONS: The overall 1-year mortality outcome of patients with severe aortic stenosis improved in the posttranscatheter AVR era compared with the pretranscatheter AVR era, with no noticeable improvement in hospitalization for heart failure.
Takeji et al. (Fri,) reported a other. In the post-TAVR era, 1-year all-cause mortality for severe aortic stenosis patients decreased to 10.2% from 16.0%, with a hazard ratio of 0.55 (95% CI, 0.47–0.63).
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