Key result
Urgent or emergency transcatheter aortic valve implantation was associated with a significantly lower 1-year all-cause death-free survival compared to elective procedures (77.2% vs. 92.2%, HR 1.89 for mortality).
Why the study?
Limited data were available on clinical outcomes in patients undergoing urgent or emergency TAVI.
Does urgent or emergency transcatheter aortic valve implantation affect 1-year mortality compared to elective procedures in patients with severe aortic stenosis?
Cohort (n=25,495)
Yes
Does urgent or emergency transcatheter aortic valve implantation affect 1-year mortality compared to elective procedures in patients with severe aortic stenosis?
Urgent or emergency TAVI is feasible with high procedural success but is associated with significantly higher 1-year mortality and periprocedural complications compared to elective TAVI, reflecting the higher baseline risk of these patients.
Answers are grounded in this paper and cite their sources.
May warrant caution with urgent/emergency TAVI; leaves open whether urgency independently drives mortality beyond higher baseline risk.
BACKGROUND: Limited data are available for clinical outcomes in patients who underwent urgent or emergency transcatheter aortic valve implantation (TAVI). This study investigated in-hospital and 1-year outcomes and explored prognostic covariates in urgent/emergency TAVI using nationwide registry data. METHODS AND RESULTS: Among 26,775 patients who underwent TAVI between August 2013 and December 2019, 25,495 with 1-year follow-up information were analyzed in this study. Baseline and procedural characteristics, as well as clinical adverse events, were compared between the urgent/emergency and elective TAVI groups. The primary outcome was all-cause mortality within 1 year after TAVI. Multivariable Cox regression models were constructed to identify independent predictors after urgent or emergency TAVI. Urgent or emergency TAVI was performed in 578 (2.3%) patients. The Society of Thoracic Surgeons score was significantly higher in the urgent/emergency than elective TAVI group (13.3% vs. 6.0%; P<0.001). Device success rate was comparable between the 2 groups. All-cause death-free survival within 1 year was lower in the urgent/emergency than elective TAVI group (77.2% vs. 92.2%; log rank P<0.001). Malignancy, albumin and creatinine concentrations, ejection fraction, and mean pressure gradient were associated with 1-year mortality in the urgent/emergency TAVI group. CONCLUSIONS: Despite higher surgical risk and more comorbidities, the procedure was successfully performed in patients undergoing urgent/emergency TAVI, although it should be noted that prognosis was worse than for elective TAVI.
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Kitahara et al. (2022) conducted a cohort in Severe aortic stenosis (n=25,495). Urgent or emergency TAVI vs. Elective TAVI was evaluated on All-cause death-free survival within 1 year (HR 1.89, 95% CI 1.53-2.32, p=<0.001). Urgent or emergency transcatheter aortic valve implantation was associated with a significantly lower 1-year all-cause death-free survival compared to elective procedures (77.2% vs. 92.2%, HR 1.89 for mortality).
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