Patients with AL amyloidosis undergoing procedures requiring anesthesia had a higher 30-day all-cause mortality rate compared to those with ATTR amyloidosis (2.7% vs. 0.5%; OR 5.71).
Cohort (n=160)
No
What are the procedural types and 30-day mortality rates in patients with AL versus ATTR cardiac amyloidosis undergoing procedures requiring anesthesia?
Patients with cardiac amyloidosis undergoing procedures requiring anesthesia face substantial postoperative risk, with a 30-day mortality of 1.7% and a higher risk observed in AL compared to ATTR amyloidosis.
Effect estimate: OR 5.71
Absolute Event Rate: 2.7% vs 0.5%
BACKGROUND: Amyloidosis is a complex disease with a multitude of sequalae, particularly with the variants that cause cardiac amyloidosis. There is minimal literature on the types of procedures these patients undergo and the associated postprocedural outcomes. This gap of knowledge makes it difficult for anesthesia providers to risk stratify amyloidosis patients. The primary outcome was 30-day all-cause mortality. Secondary outcomes included other postoperative complications and analysis of types of procedures requiring anesthesia. METHODS: This is a single-center, retrospective chart review study performed at a tertiary care medical center that serves as a referral center for patients with amyloidosis. Patients with a known diagnosis of transthyretin (ATTR) or light chain (AL) amyloidosis who underwent procedures requiring anesthesia between January 1, 2018 and October 24, 2024 were included in the study. Data analysis was performed to assess patient demographics, procedural tendency, and postoperative outcomes. RESULTS: During the study period, 160 patients underwent a total of 466 procedures requiring anesthesia. Overall, 30-day mortality rate for all encounters was 1.7% (2.7% AL vs. 0.5% ATTR, OR 5.71). Endoscopy was the most common procedure, accounting for 26.6% of all procedures. At the patient level, several procedures were more common in ATTR patients including TEE/Cardioversions (21.7% vs. 6.6%, p = 0.008), electrophysiology (36.2% vs. 9.9%, p < 0.001), and neurosurgery (13.0% vs. 3.3%, p = 0.031). CONCLUSIONS: In conclusion, patients with amyloid variants that cause cardiac amyloidosis carry substantial postoperative risk when undergoing procedures, with a trend toward increased mortality in patients with AL compared to ATTR. Patients with ATTR are more likely to require neurosurgery and treatment of arrythmias than patients with AL. Additional studies are needed to determine specific diagnostic parameters to help optimize these patients in the future. TRIAL REGISTRATION: Not applicable. Not a clinical trial.
Smith et al. (Thu,) conducted a cohort in Cardiac variant amyloidosis (ATTR or AL) (n=160). AL amyloidosis vs. ATTR amyloidosis was evaluated on 30-day all-cause mortality (OR 5.71). Patients with AL amyloidosis undergoing procedures requiring anesthesia had a higher 30-day all-cause mortality rate compared to those with ATTR amyloidosis (2.7% vs. 0.5%; OR 5.71).
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