Key result
TAVR is linked to ~68% fewer deaths and HF readmissions in AS with cardiac amyloidosis.
Why the study?
Although the co-prevalence of aortic stenosis and cardiac amyloidosis is increasingly recognized, the role of TAVR in patients with cardiac amyloidosis remains unclear.
Does transcatheter aortic valve replacement (TAVR) improve the composite of all-cause mortality and heart failure readmissions in patients with aortic stenosis and cardiac amyloidosis?
Cohort (n=1,127)
Yes
Does transcatheter aortic valve replacement (TAVR) improve the composite of all-cause mortality and heart failure readmissions in patients with aortic stenosis and cardiac amyloidosis?
Effect estimate: HR 0.32 (95% CI 0.14-0.71)
Absolute Event Rate: 8.9% vs 24.4%
p-value: p=0.007
In patients with concurrent aortic stenosis and cardiac amyloidosis, TAVR is associated with a significantly lower risk of heart failure readmissions and the composite of mortality and HF readmissions compared to conservative management.
Supports TAVR evaluation in aortic stenosis with cardiac amyloidosis; leaves open randomized confirmation of benefit.
Background: Though the co-prevalence of aortic stenosis (AS) and cardiac amyloidosis (CA) is increasingly recognized, the role of transcatheter aortic valve replacement (TAVR) in patients with CA remains unclear. Methods: The National Readmission Dataset (2016-18) and ICD-10 codes were used to identify those with CA and AS, in conjunction with TAVR status. The primary outcome was a composite of heart failure (HF) readmissions and all-cause mortality. All outcomes were followed up to 1-year with a median follow up time 172-days. Kaplan-Meier curves and multivariate cox-proportional hazard regression were used for time-to-event analysis. Results: Of 1,127 CA patients, 92 (8.2%) had undergone TAVR. Patients with CA who received TAVR were younger and more commonly had coronary artery disease (67.3% vs 44.2%). Teaching (93.6% vs 81.1%) and large hospitals (77.7% vs 59.3%) performed more TAVRs. In multivariate analysis, TAVR was associated with an improved primary outcome (8.9% vs 24.4%, HR:0.32; 95% CI 0.14-0.71, p = 0.007) and with reduced HF readmissions (3.8% vs 19.4%, HR:0.22; 95% CI 0.07-0.68, p = 0.008). All-cause mortality was numerically lower in TAVR patients with CA but did not reach statistical significance. Conclusions: CA patients who receive TAVR are younger, and the procedure is more commonly performed at large, teaching hospitals. TAVR was associated with a lower primary composite outcome of HF readmissions and all-cause mortality.
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Khawaja et al. (2022) conducted a cohort in Aortic stenosis and cardiac amyloidosis (n=1,127). Transcatheter aortic valve replacement (TAVR) vs. No TAVR was evaluated on Composite of all-cause mortality and heart failure readmissions (HR 0.32, 95% CI 0.14-0.71, p=0.007). Transcatheter aortic valve replacement was associated with a significantly lower rate of the composite outcome of heart failure readmissions and all-cause mortality (HR 0.32) compared to no TAVR in patients with aortic stenosis and cardiac amyloidosis.
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