Key result
Concomitant COPD was associated with higher long-term all-cause mortality after TAVI (52.6% vs. 17.8%; OR 4.73), though this effect was no longer significant after adjusting for frailty indices.
Why the study?
Does chronic obstructive pulmonary disease (COPD) increase long-term mortality and affect quality of life in patients with severe aortic stenosis undergoing TAVI?
Cohort (n=148)
No
Does chronic obstructive pulmonary disease (COPD) increase long-term mortality and affect quality of life in patients with severe aortic stenosis undergoing TAVI?
Odds Ratio: 4.73 (95% CI 1.69–13.24)
Absolute Event Rate: 52.6% vs 17.8%
p-value: p=0.002
While COPD is associated with higher long-term mortality after TAVI, this effect appears largely driven by coexisting comorbidities and frailty, and quality of life improves similarly regardless of COPD status.
COPD should not yet alter TAVI risk assessment; leaves open frailty's role in observational mortality associations.
Association between chronic obstructive pulmonary disease (COPD) and long-term mortality as well as the quality of life (QoL) in patients with severe aortic stenosis (AS) undergoing transcatheter aortic valve implantation (TAVI) is still unclear. We sought to evaluate the impact of COPD on mortality and QoL of patients with AS undergoing TAVI. A total of 148 consecutive patients who underwent TAVI were enrolled and stratified by history of COPD. Of 148 patients enrolled, 19 (12.8%) patients had a history of COPD. Patients with COPD were high-risk patients with higher prevalence of incomplete revascularization and frailty features. At follow-up of 15.8 months, all-cause mortality in patients with COPD was over four times higher than in patients without COPD [17.8% vs. 52.6%; p = 0.002—age/gender-adjusted OR (95% CI) 4.73 (1.69–13.24)]. On the other hand, in Cox regression model, the only independent predictors of all-cause death at long-term follow-up were: incomplete coronary revascularization [HR (95% CI) 5.45 (2.38–12.52); p = 0.001], estimated glomerular filtration rate [per 1 ml/min/1.73 m 2 increase: 0.96 (0.94–0.98); p = 0.001], and previous stroke/transient ischemic attack [2.86 (1.17–7.00); p = 0.021]. Also, the difference in mortality between patients with and without COPD was not significant after adjustment for the most of frailty indices. Importantly, groups were comparable in terms of QoL at baseline and 12 months. COPD may pose an important factor affecting long-term outcomes of patients with severe AS undergoing TAVI. However, its effects might be partially related to coexisting comorbidities and frailty.
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Dziewierz et al. (2017) conducted a cohort in Symptomatic severe aortic stenosis (n=148). Chronic obstructive pulmonary disease (COPD) vs. No history of COPD was evaluated on All-cause mortality at maximal follow-up (median 15.8 months) (OR 4.73, 95% CI 1.69-13.24, p=0.002). Concomitant COPD was associated with higher long-term all-cause mortality after TAVI (52.6% vs. 17.8%; OR 4.73), though this effect was no longer significant after adjusting for frailty indices.
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