Key result
Black, Asian, and Hispanic race associated with comparable or lower MACE versus White TAVR patients.
Why the study?
Racial and ethnic disparities in utilization and outcomes of balloon-expandable TAVR remain incompletely understood despite its transformative role in severe aortic stenosis.
Does race/ethnicity impact the utilization and 1-year clinical outcomes of patients undergoing balloon-expandable TAVR?
Observational (n=395,618)
Yes
Does race/ethnicity impact the utilization and 1-year clinical outcomes of patients undergoing balloon-expandable TAVR?
Effect estimate: HR 1.00 (Black), HR 0.91 (Asian), HR 0.89 (Hispanic) (95% CI 0.97-1.03 (Black), 0.86-0.97 (Asian), 0.86-0.91 (Hispanic))
p-value: p=0.82 (Black), <0.01 (Asian), <0.01 (Hispanic)
Despite lower utilization rates, minority patients undergoing balloon-expandable TAVR have comparable or lower 1-year major adverse cardiac event rates compared to White patients.
Highlights potential TAVR access disparities; observational registry data leaves open causal factors and mitigation strategies.
Background Aortic stenosis is the most frequently acquired native valve disease. Transcatheter aortic valve replacement (TAVR) has emerged as a transformative intervention for patients with severe aortic stenosis. Despite its success, studies have shed light on racial and ethnic disparities in utilization and outcomes of TAVR. Methods Using the Transcatheter Valve Therapy Registry between November 2011 through June 2023, we evaluated volume trends of SAPIEN balloon-expandable TAVR performed by race/ethnicity, and its association with in-hospital and 1-year outcomes after the procedure. Results In the 12-year period, 395,618 patients were identified; 357,729 (90.42%) were White, 18,810 (4.75%) Hispanic, 15,100 (3.82%) Black, and 3979 (1.01%) Asian. There was an overall rising trend in proportional usage of TAVR among Hispanics (from 3.3% in 2011/2012 to 5.2% in 2023, P < .01) and Asian patients (from 1.1% in 2011/2012 to 1.3% in 2023, P < .01). Adjusted 1-year major adverse cardiac events (all-cause mortality, stroke, or rehospitalization) were comparable among Black patients (hazard ratio [HR], 1.00; 95% CI, 0.97-1.03; P = .82) and lower among Asian (HR, 0.91; 95% CI, 0.86-0.97; P < .01) and Hispanic patients (HR, 0.89; 95% CI, 0.86-0.91; P < .01) compared with White patients. Conclusions Evidence supports favorable outcomes across different ethnic groups, despite the presence of higher levels of comorbidities and lower TAVR utilization. Modest improvements in TAVR utilization disparities among Asian and Hispanic patients have occurred since its introduction; however, utilization in Black patients remains low despite favorable outcomes. Further efforts are needed to understand the reasons and mitigate disparities in minority patients.
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Vedantam et al. (2025) conducted an observational in Severe aortic stenosis (n=395,618). Non-White race/ethnicity (Black, Asian, Hispanic) vs. White race/ethnicity was evaluated on 1-year major adverse cardiac events (all-cause mortality, stroke, or rehospitalization) (HR 1.00 (Black), HR 0.91 (Asian), HR 0.89 (Hispanic), 95% CI 0.97-1.03 (Black), 0.86-0.97 (Asian), 0.86-0.91 (Hispanic), p=0.82 (Black), <0.01 (Asian), <0.01 (Hispanic)). Black, Asian, and Hispanic race/ethnicity were associated with comparable (HR 1.00) or lower (HR 0.91 and HR 0.89, respectively) 1-year major adverse cardiac events compared with White TAVR patients.
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