Atrial fibrillation in patients undergoing transcatheter aortic valve implantation was associated with higher 1-year all-cause mortality compared to no AF (30.9% vs 13.9%; HR 2.36; P=0.0008).
Cohort (n=389)
Does atrial fibrillation increase the risk of mortality and adverse outcomes in high-risk patients undergoing transcatheter aortic valve implantation?
Atrial fibrillation is common in high-risk patients undergoing transcatheter aortic valve implantation and is associated with a more than 2-fold increased risk of all-cause mortality at 1 year.
Effect estimate: HR 2.36 (95% CI 1.43-3.90)
Absolute Event Rate: 30.9% vs 13.9%
p-value: p=0.0008
BACKGROUND: Atrial fibrillation (AF) is an important risk factor for stroke and is common among elderly patients undergoing transcatheter aortic valve implantation. The aim of this study was to assess the impact of AF on clinical outcomes among patients undergoing transcatheter aortic valve implantation. METHODS AND RESULTS: Between August 2007 and October 2011, a total of 389 high-risk patients undergoing transcatheter aortic valve implantation were included into a prospective registry. AF was recorded in 131 patients (33.7%) with a mean CHA(2)DS(2)-VASC score of 4.5±1.2 and was paroxysmal in 26 (25.0%), persistent in 8 (7.7%), and permanent in 70 patients (67.3%). Patients with and without AF had similar baseline characteristics except for fewer revascularization procedures (coronary artery bypass grafting: 12% versus 22%; P=0.03) among AF patients. At 1 year, all-cause mortality was higher among patients with AF (30.9%) compared with those without AF (13.9%; hazard ratio HR, 2.36; 95% confidence interval CI, 1.43-3.90; P=0.0008). This was observed irrespective of the type of AF (permanent, HR, 2.47; 95% CI, 1.40-4.38; persistent, HR, 3.60; 95% CI, 1.10-11.78; paroxysmal, HR, 2.88; 95% CI, 1.37-6.05). Mortality gradually increased with higher CHA(2)DS(2)-VASC scores (score 1-3: HR, 2.20; 95% CI, 0.92-5.27; score 6-8: HR, 4.12; 95% CI, 2.07-8.20). The risks of stroke (3.9% versus 5.1%; HR, 0.76; 95% CI, 0.23-1.96; P=0.47) and life-threatening bleeding (19.8% versus 14.7%; HR, 1.37; 95% CI, 0.86-2.19; P=0.19) were similar among patients with and without AF. CONCLUSIONS: AF is common among high-risk patients with severe aortic stenosis undergoing transcatheter aortic valve implantation and is associated with a >2-fold increased risk of all-cause and cardiovascular mortality, irrespective of the type of AF. The gradient of risk directly correlates with the CHA(2)DS(2)-VASC score.
Stortecky et al. (Fri,) conducted a cohort in Atrial fibrillation and aortic stenosis (n=389). Atrial fibrillation vs. No atrial fibrillation was evaluated on All-cause mortality at 1 year (HR 2.36, 95% CI 1.43-3.90, p=0.0008). Atrial fibrillation in patients undergoing transcatheter aortic valve implantation was associated with higher 1-year all-cause mortality compared to no AF (30.9% vs 13.9%; HR 2.36; P=0.0008).