Why the study?
Concomitant ATTR-CA is increasingly recognized among elderly patients with severe AS referred for TAVI, but its impact on early and late outcomes remains incompletely defined.
Does concomitant transthyretin cardiac amyloidosis worsen early and late outcomes in patients undergoing TAVI for severe aortic stenosis compared to isolated aortic stenosis?
Systematic Review (n=645,744)
Does concomitant transthyretin cardiac amyloidosis worsen early and late outcomes in patients undergoing TAVI for severe aortic stenosis compared to isolated aortic stenosis?
Concomitant ATTR-CA in patients undergoing TAVI for severe AS is associated with similar 30-day mortality but higher rates of AKI, pacemaker implantation, late heart failure readmissions, and late all-cause mortality compared to isolated AS.
Concomitant transthyretin cardiac amyloidosis (ATTR-CA) is increasingly recognized among elderly patients with severe aortic stenosis (AS) referred to transcatheter aortic valve implantation (TAVI), yet its impact on early and late outcomes remains incompletely defined. We conducted a systematic review of studies comparing TAVI outcomes in patients with isolated AS and those with AS+ATTR-CA. Eleven observational studies were included, comprising 644,107 patients with isolated AS and 1,637 with AS+ATTR-CA. AS+ATTR-CA patients were older, more frequently male, and showed more atrial fibrillation, mildly reduced left ventricular ejection fraction, and markedly elevated cardiac biomarkers. Thirty-day mortality was low and similar between groups, with no consistent differences in stroke or major bleeding, whereas acute kidney injury and permanent pacemaker implantation were more frequent in AS+ATTR-CA. During follow-up, AS+ATTR-CA patients experienced higher heart failure readmissions and late all-cause mortality. ATTR-CA should not preclude TAVI but should inform risk stratification, peri-procedural management, and post-TAVI follow-up.
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Giusti et al. (2026) conducted a systematic review in Severe aortic stenosis referred to transcatheter aortic valve implantation (TAVI) (n=645,744). Concomitant transthyretin cardiac amyloidosis (ATTR-CA) vs. Isolated severe aortic stenosis was evaluated on Early and late outcomes including 30-day mortality, stroke, major bleeding, acute kidney injury, permanent pacemaker implantation, heart failure readmissions, and late all-cause mortality.