Transcatheter aortic valve replacement was associated with a significantly lower rate of the composite outcome of heart failure readmissions and all-cause mortality (HR 0.32) compared to no TAVR in patients with aortic stenosis and cardiac amyloidosis.
Cohort (n=1,127)
Yes
Does transcatheter aortic valve replacement (TAVR) improve the composite of all-cause mortality and heart failure readmissions in patients with aortic stenosis and cardiac amyloidosis?
In patients with concurrent aortic stenosis and cardiac amyloidosis, TAVR is associated with a significantly lower risk of heart failure readmissions and the composite of mortality and HF readmissions compared to conservative management.
Effect estimate: HR 0.32 (95% CI 0.14-0.71)
Absolute Event Rate: 8.9% vs 24.4%
p-value: p=0.007
Background: Though the co-prevalence of aortic stenosis (AS) and cardiac amyloidosis (CA) is increasingly recognized, the role of transcatheter aortic valve replacement (TAVR) in patients with CA remains unclear. Methods: The National Readmission Dataset (2016-18) and ICD-10 codes were used to identify those with CA and AS, in conjunction with TAVR status. The primary outcome was a composite of heart failure (HF) readmissions and all-cause mortality. All outcomes were followed up to 1-year with a median follow up time 172-days. Kaplan-Meier curves and multivariate cox-proportional hazard regression were used for time-to-event analysis. Results: Of 1,127 CA patients, 92 (8.2%) had undergone TAVR. Patients with CA who received TAVR were younger and more commonly had coronary artery disease (67.3% vs 44.2%). Teaching (93.6% vs 81.1%) and large hospitals (77.7% vs 59.3%) performed more TAVRs. In multivariate analysis, TAVR was associated with an improved primary outcome (8.9% vs 24.4%, HR:0.32; 95% CI 0.14-0.71, p = 0.007) and with reduced HF readmissions (3.8% vs 19.4%, HR:0.22; 95% CI 0.07-0.68, p = 0.008). All-cause mortality was numerically lower in TAVR patients with CA but did not reach statistical significance. Conclusions: CA patients who receive TAVR are younger, and the procedure is more commonly performed at large, teaching hospitals. TAVR was associated with a lower primary composite outcome of HF readmissions and all-cause mortality.
Khawaja et al. (Mon,) conducted a cohort in Aortic stenosis and cardiac amyloidosis (n=1,127). Transcatheter aortic valve replacement (TAVR) vs. No TAVR was evaluated on Composite of all-cause mortality and heart failure readmissions (HR 0.32, 95% CI 0.14-0.71, p=0.007). Transcatheter aortic valve replacement was associated with a significantly lower rate of the composite outcome of heart failure readmissions and all-cause mortality (HR 0.32) compared to no TAVR in patients with aortic stenosis and cardiac amyloidosis.