Key result
Nonurgent TAVR linked to ~22% lower in-hospital mortality versus urgent TAVR.
Why the study?
Data regarding the clinical outcomes of transcatheter aortic valve replacement performed in an urgent setting were limited.
Does nonurgent TAVR reduce in-hospital mortality and complications compared to urgent TAVR?
Observational (n=42,154)
Yes
Does nonurgent TAVR reduce in-hospital mortality and complications compared to urgent TAVR?
Odds Ratio: 0.78 (95% CI 0.69–0.89)
p-value: p=<.001
Although urgent TAVR is associated with higher in-hospital mortality and complications compared to nonurgent TAVR, the absolute differences are not remarkably high, suggesting it remains a reasonable approach when clinically indicated.
Urgent TAVR accounts for 24% of cases; leaves open comparative outcomes versus elective procedures in observational data.
BACKGROUND: There is a paucity of data regarding the outcomes of transcatheter valve replacement (TAVR) performed in an urgent clinical setting. METHODS: The Nationwide Inpatient Sample (NIS) database years 2011-2014 was used to identify hospitalizations for TAVR in the urgent setting. Using propensity score matching, we compared patients who underwent TAVR in nonurgent versus urgent settings. RESULTS: Among 42,154 hospitalizations in which TAVR was performed, 10,114 (24%) underwent urgent TAVR. There was an uptrend in the rate of urgent TAVR procedures (p = .001). The rates of in-hospital mortality among this group did not change during the study period (p = .713). Nonurgent TAVR was associated with lower mortality (odds ratio [OR] = 0.78; 95% confidence interval [CI]: 0.69-0.89, p < .001) compared with urgent TAVR. Nonurgent TAVR was associated with lower incidence of cardiogenic shock (OR = 0.46; 95%CI: 0.40-0.53 p < .001), use of mechanical circulatory support devices (OR = 0.69; 95%CI: 0.59-0.82, p < .001), AKI (OR = 0.60; 95%CI: 0.56-0.64 p < .001), hemodialysis (OR = 0.67; 95%CI: 0.56-0.80 p < .001), major bleeding (OR = 0.94; 95%CI: 0.89-0.99 p = .045) and shorter length of stay (7.08 ± 6.317 vs. 12.39 ± 9.737 days, p < .001). There was no difference in acute stroke (OR = 0.96; 95%CI: 0.81-1.14, p = .636), vascular complications (OR = 1.07; 95%CI: 0.89-1.29, p = .492), and pacemaker insertions (OR = 0.92; 95%CI: 0.84-1.01, p = .067) between both groups. Among those undergoing urgent TAVR, subgroup analysis showed higher mortality in patients ≤80 years (p = .033), women (p < .001), chronic kidney disease (p = .001), heart failure (p < .001), and liver disease (p = .003). CONCLUSION: In this large nationwide analysis, almost a quarter of TAVR procedures were performed in the urgent settings. Although urgent TAVR was associated with higher mortality and increased complications compared with nonurgent TAVR, the absolute difference in in-hospital mortality was not remarkably higher. Thus, urgent TAVR can be considered as a reasonable approach when indicated.
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Elbadawi et al. (2019) conducted an observational in Transcatheter aortic valve replacement (n=42,154). Nonurgent TAVR vs. Urgent TAVR was evaluated on In-hospital mortality (OR 0.78, 95% CI 0.69-0.89, p=<.001). Nonurgent TAVR was associated with lower in-hospital mortality compared with urgent TAVR (OR 0.78; 95% CI 0.69-0.89; p<0.001).
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