Key result
Post-TAVI clinical events are linked to significantly higher mortality, with major bleeding occurring earliest.
Why the study?
Although outcomes after TAVI have improved, long-term HF, ischemic, and bleeding events remain important clinical challenges in patients with severe AS, and their timing and prognostic impact are not fully understood.
Does the occurrence and timing of post-discharge heart failure hospitalization, ischemic events, or major bleeding impact all-cause mortality in patients with severe aortic stenosis undergoing transcatheter aortic valve implantation?
Cohort (n=988)
Yes
Does the occurrence and timing of post-discharge heart failure hospitalization, ischemic events, or major bleeding impact all-cause mortality in patients with severe aortic stenosis undergoing transcatheter aortic valve implantation?
After TAVI for severe aortic stenosis, post-discharge major bleeding occurs earlier than heart failure or ischemic events, though all three event types carry a similarly high risk of subsequent 1-year all-cause mortality (~25%-32%).
Earlier post-TAVI bleeding timing supports prioritized surveillance; leaves open whether preventing any event type modifies mortality.
Background Although outcomes after transcatheter aortic valve implantation (TAVI) have improved, long-term heart failure (HF), ischemic, and bleeding events remain important clinical challenges in patients with severe aortic stenosis (AS), and their timing and prognostic impact are not fully understood. Purpose This study aimed to investigate the incidence, timing, and prognostic impact of HF, ischemic, and bleeding events after TAVI. Methods This was a two-center retrospective registry study including 988 patients with severe AS who underwent TAVI. Patients were classified according to the first clinical event after discharge: HF hospitalization, ischemic events (myocardial infarction and ischemic stroke), major bleeding (Valve Academic Research Consortium-3 type 2-4), or event-free group. All-cause mortality and time to first event after discharge were evaluated among the 4 groups during the follow-up of up to 5 years. Results During a median follow-up of 665 days after discharge, 165 patients (16.7%) experienced clinical events. Based on the first event after discharge, 80 (8.1%), 32 (3.2%), and 53 (5.4%) patients were classified into the HF hospitalization, ischemic events, and major bleeding groups, respectively, while the remaining 823 (83.3%) were categorized as the event-free group. All-cause mortality after discharge was significantly higher in patients with clinical events than in those without (P<0.001). Major bleeding occurred earlier than HF and ischemic events (median 142 [interquartile range, 47-328], 294 [52-1008], and 339 [44-741] days after discharge, respectively, P=0.004: Figure 1). Among the 3 event groups, all-cause mortality did not differ when assessed from the time of the first event (1-year mortality 31.5% [95% CI 21.6-44.4] for HF hospitalization, 30.4% [15.4-54.4] for ischemic events, and 25.4% [14.6-42.0] for major bleeding; P=0.970; Figure 2). Conclusions In patients with severe AS, major bleeding occurred earlier, and any post-discharge clinical events were associated with increased mortality after TAVI, without significant between-group differences in prognostic impact. These findings support tailored follow-up for HF, ischemic, and bleeding events after TAVI.Figure 1Figure 2
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Okita et al. (2026) conducted a cohort in Severe aortic stenosis undergoing transcatheter aortic valve implantation (TAVI) (n=988). First post-discharge clinical event (heart failure hospitalization, ischemic event, or major bleeding) vs. Event-free after discharge was evaluated on All-cause mortality and time to first event after discharge (p=<0.001). Post-TAVI clinical events (16.7%) significantly increased mortality vs no events (P<0.001), with major bleeding occurring earliest (median 142 days, P=0.004) and similar 1-year post-event mortality (25.4%-31.5%, P=0.970).
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