Key result
Post-TAVR era linked to ~48% lower 1-year mortality in severe aortic stenosis.
Why the study?
Data were scarce regarding changes in patient backgrounds, clinical practice, and outcomes of patients with severe aortic stenosis before and after the introduction of TAVR.
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?
Cohort (n=6,645)
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?
Hazard Ratio: 0.52 (95% CI 0.42–0.64)
Absolute Event Rate: 10.2% vs 16%
p-value: p=<0.001
The overall 1-year prognosis of patients with severe aortic stenosis in Japan has significantly improved in the post-TAVR era, with a 48% relative reduction in mortality risk compared to the pre-TAVR era.
Post-TAVR era care was associated with lower mortality; extends prior observational data but leaves causality open.
Background There is a scarcity of data on the changes in patients backgrounds, clinical practice and outcomes of patients with severe aortic stenosis (AS) before and after introduction of transcatheter aortic valve replacement (TAVR). Purpose We sought to comprehensively assess the changes in patients demographics, treatment strategies, and short-term outcomes of patients with severe AS before and after introduction of TAVR in Japan. Methods The current study population consisted of 6645 patients from the CURRENT AS Registry (Registry-1: 3448 consecutive patients with severe AS before approval of TAVR from January 2003 to December 2011; Registry-2: 3197 consecutive patients with severe AS after approval of TAVR from April 2018 and December 2020). Primary outcome was all-cause death at 1 year. Results The mean age of patients was significantly older in Registry-2 (81.7 years) than in Registry-1 (77.8 years). The prevalence of acute heart failure at baseline was 20.2% in Registry-1 and 9.7% in Registry-2, reflecting a significant reduction in heart failure severity in Registry-2. Regarding treatment strategies, initial aortic valve replacement (AVR) strategy was adopted only in 31.3% of patients in Registry-1 with surgical AVR (SAVR), and in 49.9% of patients in Registry-2 with SAVR and TAVR. Among patients initially selected for conservative management, conversion to AVR was more frequent in Registry-2 (17.0%) than in Registry-1 (6.7%) during the 1-year follow-up.The cumulative 1-year incidence of all-cause death was significantly lower in Registry-2 compared to Registry-1 (10.2% versus 16.0%; log-rank P<0.001)(Figure 1). The lower adjusted risk of Registry-2 relative to Registry-1 remained significant for all-cause death (HR: 0.52, 95% CI: 0.42–0.64, P<0.001). This significant reduction in mortality risk was also observed among patients who were managed conservatively (HR: 0.58, 95% CI: 0.46–0.74, P<0.001). Conclusions The overall prognosis of patients with severe AS has significantly improved in the post-TAVR era compared to the pre-TAVR era. Notably, this improvement was also evident among patients who were managed with conservative strategies.
No takes yet. Share an insight, caveat, or question.
Takeji et al. (2025) conducted a cohort in severe aortic stenosis (n=6,645). Post-TAVR era vs. Pre-TAVR era was evaluated on all-cause death at 1 year (HR 0.52, 95% CI 0.42-0.64, p=<0.001). The post-TAVR era was associated with a significantly lower 1-year incidence of all-cause death compared to the pre-TAVR era (10.2% vs 16.0%; HR 0.52; 95% CI 0.42-0.64; P<0.001).
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: