Key result
High Charlson Comorbidity Index linked to ~36% higher in-hospital VARC-2 composite adverse events.
Why the study?
The impact of Charlson Comorbidity Index on in-hospital outcomes and the comparative efficacy of TAVR versus SAVR in aortic stenosis patients with different comorbidity burdens was unclear.
Does a high Charlson Comorbidity Index predict worse in-hospital outcomes in patients with aortic stenosis undergoing aortic valve replacement, and does TAVR improve outcomes compared to SAVR across different comorbidity burdens?
Observational (n=3,380)
No
Does a high Charlson Comorbidity Index predict worse in-hospital outcomes in patients with aortic stenosis undergoing aortic valve replacement, and does TAVR improve outcomes compared to SAVR across different comorbidity burdens?
Odds Ratio: 1.36 (95% CI 1.17–1.58)
Absolute Event Rate: 50.3% vs 44.2%
p-value: p=<0.001
High comorbidity burden (CCI ≥2) independently predicts worse in-hospital outcomes after aortic valve replacement, but TAVR demonstrates superior early safety compared to SAVR in patients aged ≥65 years regardless of comorbidity burden.
Supports incorporating CCI into TAVR risk models; hypothesis-generating and should not yet change practice.
OBJECTIVES: This study aimed to evaluate the impact of the Charlson Comorbidity Index (CCI) on in-hospital outcomes in patients with aortic stenosis (AS) undergoing aortic valve replacement (AVR) and to compare the efficacy of transcatheter aortic valve replacement (TAVR) and surgical aortic valve replacement (SAVR) in patients with different comorbidity burdens. SETTING: The National Clinical Research Center for Cardiovascular Diseases. PARTICIPANTS: A retrospective analysis was conducted on 3380 AS patients who underwent AVR in Beijing Anzhen Hospital from January 2015 to October 2021. INTERVENTIONS: Patients were stratified into low (0-1) and high (≥2) CCI groups. PRIMARY AND SECONDARY OUTCOME MEASURES: The primary outcome was Valve Academic Research Consortium-2 (VARC-2) composite early safety endpoints. RESULTS: Patients with high CCI scores exhibited significantly higher rates of VARC-2 composite adverse outcomes compared with those with low scores (50.3% vs 44.2%, p=0.001). After adjusting for confounding factors, high CCI scores were independently associated with the VARC-2 composite adverse outcomes (OR=1.36, 95% CI 1.17 to 1.58, p<0.001). In patients aged ≥65 years, TAVR demonstrated lower composite event rates compared with SAVR, regardless of CCI score (low CCI: 17.6% vs 54.3%, p<0.001; high CCI: 33.7% vs 62.8%, p<0.001). CONCLUSIONS: CCI is a significant predictor of in-hospital composite adverse events in AS patients undergoing AVR. TAVR may be preferred over SAVR for patients aged ≥65 years, irrespective of comorbidity burden, to minimise composite events risk. These findings underscore the importance of considering comorbidity burden in treatment decision-making for AS patients. TRIAL REGISTRATION NUMBER: NCT05797402.
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Huang et al. (2025) conducted an observational in Aortic stenosis (n=3,380). High Charlson Comorbidity Index (≥2) vs. Low Charlson Comorbidity Index (0-1) was evaluated on Valve Academic Research Consortium-2 (VARC-2) composite early safety endpoints (OR 1.36, 95% CI 1.17 to 1.58, p=<0.001). High Charlson Comorbidity Index scores (≥2) were independently associated with increased in-hospital VARC-2 composite adverse outcomes compared to low scores (OR 1.36; 95% CI 1.17-1.58; p<0.001).
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