Key result
Discordant AS shows similar long-term mortality to concordant AS after TAVR.
Why the study?
The study aimed to evaluate clinical outcomes following TAVR in patients with symptomatic discordant aortic stenosis.
Does transcatheter aortic valve replacement (TAVR) result in different all-cause mortality in patients with discordant aortic stenosis compared to those with concordant aortic stenosis?
Cohort (n=2,021)
No
Does transcatheter aortic valve replacement (TAVR) result in different all-cause mortality in patients with discordant aortic stenosis compared to those with concordant aortic stenosis?
Hazard Ratio: 0.89 (95% CI 0.77–1.02)
p-value: p=0.09
Patients with symptomatic severe aortic stenosis and discordant echocardiographic findings have similar long-term survival outcomes after TAVR compared to those with concordant findings, despite higher 1-year mortality and MI readmission rates.
This study aimed to evaluate clinical outcomes of patients with symptomatic discordant (aortic stenosis) AS following transcatheter aortic valve replacement (TAVR). This is a retrospective cohort study. Patients who underwent a TAVR for severe symptomatic native AS with preserved left ventricular ejection fraction ≥50% from 2012 to 2022 at our institution were included. Patients were divided into two cohorts, concordant AS (met all AS criteria) and discordant AS (< 3 criteria). TAVR. The primary endpoint was all cause mortality and secondary outcomes were hospital readmissions for myocardial infarction (MI) and stroke. This study evaluated 2021 patients; the median age was 82.6 (77.0–87.2) years, and 53% were female. There was no difference in long-term mortality between discordant or concordant AS (HR: 0.89 [95% CI: 0.77–1.02]; P = 0.09). However, the discordant group had a higher 1-year mortality rate than the concordant group (14.5% vs 10.1%, respectively; P = 0.0054) and comparable mortality rates at 5 years (52.0% vs 50.5%, respectively; P = 0.18). The long-term readmission rate for MI was higher for the discordant group (HR: 0.47 [95% CI: 0.27–0.80]; P = 0.005), and there was no difference in readmission for stroke or transient ischemic attack (HR: 1.33 [95% CI: 0.92–1.94]; P = 0.133). Patients with symptomatic severe AS with discordant echocardiographic findings may have similar survival outcomes than those with concordant AS after undergoing TAVR. • 94% of discordant aortic stenosis patients meet the aortic valve area criterion. • Patients with discordant AS have more cardiovascular comorbidities. • Patients with discordant AS are at a higher risk for myocardial infarction. • Concordant and discordant AS patients have a similar prognosis after TAVR.
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Hundal et al. (2026) conducted a cohort in Severe symptomatic native aortic stenosis (n=2,021). Discordant aortic stenosis vs. Concordant aortic stenosis was evaluated on All-cause mortality (HR 0.89, 95% CI 0.77-1.02, p=0.09). In patients undergoing TAVR, discordant aortic stenosis was associated with similar long-term all-cause mortality compared to concordant aortic stenosis (HR 0.89; 95% CI 0.77-1.02; P=0.09).
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