Patients with AL amyloidosis had a 2.7-fold higher risk of death and thromboembolic events in the first 6 months versus TTR amyloidosis (HR 2.70; p=0.04).
Does light chain (AL) cardiac amyloidosis increase the risk of death and thromboembolic events compared to transthyretin (TTR) cardiac amyloidosis?
Patients with AL cardiac amyloidosis face a significantly higher early risk (first 6 months) of death and thromboembolic events compared to those with TTR amyloidosis, highlighting a potential need for early anticoagulation.
Absolute Event Rate: 0% vs 0%
Abstract Introduction Patients with cardiac amyloidosis (CA) experience a poor prognosis due to the development of heart failure, atrial arrhythmias, and thromboembolic events. Both high mortality and incidence of thromboembolic events have been reported in CA patients. However, data stratified by CA type remains limited. Materials and Methods This was a retrospective, observational cohort study including patients diagnosed with light chain (AL) and transthyretin (TTR) amyloidosis from our Institutional Amyloidosis Registry. Thromboembolic events were defined as stroke, transient ischemic attack, acute arterial ischemia, deep vein thrombosis, and pulmonary embolism. Follow-up was performed with administrative censoring at 2 years to evaluate the incidence of the primary composite endpoint of death and thromboembolic events, stratified by AL or TTR amyloidosis. Given evidence that risks vary over time according to the type of amyloidosis, follow-up was divided into three intervals: the first 6 months, 6 to 12 months, and 12 to 24 months, with separate hazard ratios (HR) estimated for each interval. Results A total of 201 patients with CA were included, 54% (n=109) with AL amyloidosis and 46% (n=92) with TTR amyloidosis. At the 2-year follow-up, the overall mortality was 25% (n=50), the incidence of thromboembolic events was 9.5% (n=19), and the composite primary endpoint was 30% (n=60). Comparing amyloidosis types, the incidence of the composite primary endpoint was higher during the first time interval (first 6 months) in patients with AL amyloidosis compared to those with TTR amyloidosis (HR 2.70; 95% CI 1.05 - 6.97; p=0.04), and similar during the second and third time intervals (HR 0.81; 95% CI 0.28 - 2.63; p=0.81 and HR 0.55; 95% CI 0.19 - 1.53; p=0.25), respectively. Conclusion In this cohort, patients with AL amyloidosis showed a higher risk of death and thromboembolic events during the early stages of follow-up compared to those with TTR amyloidosis. These findings highlight the importance of close monitoring and considering the possibility of early anticoagulation in selected patients with AL amyloidosis.
Decotto et al. (Sat,) reported a other. Patients with AL amyloidosis had a 2.7-fold higher risk of death and thromboembolic events in the first 6 months versus TTR amyloidosis (HR 2.70; p=0.04).