Comparison of Mid-Term Prognosis in Intermediate-to-Low-Risk Contemporary Population with Guidelines-Oriented Age Cutoff.
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BORIS DOI
Publisher DOI
PubMed ID
38276659
Description
BACKGROUND
Current European guidelines support transcatheter aortic valve implantation (TAVI) in intermediate-to-low-risk patients ≥75 years-old, but its prognostic relevance is unknown.
METHODS
Intermediate-to-low-risk (The Society of Thoracic Surgeons score <8%) patients enrolled in the HORSE registry were included. We compared the populations aged under 75 with those over 75. The primary endpoint was all-cause mortality.
RESULTS
A total of 2685 patients were included: 280 (8.6%) < 75 and 2405 ≥ 75 years. Through a mean follow-up of 437 ± 381 days, 198 (8.2%) and 23 (8.2%) patients died in the two arms without statistically significant differences (log-rank p = 0.925). At Cox regression analysis, age did not predict the occurrence of all-cause death, neither as a continuous variable (HR 1.01, 95% CI 0.99-1.04, p = 0.294) nor dichotomizing according to the prespecified cutoff of 75 years (HR 0.97, 95% CI 0.63-1.51, p = 0.924). Time-to-event ROC curves showed low accuracy of age to predict all-cause mortality (area under the curve of 0.54 for both 1-year and 2-year outcomes).
CONCLUSIONS
TAVI has comparable benefits across age strata for intermediate-to-low-risk patients. The age cutoff suggested by the current guidelines is not predictive of the risk of adverse events during hospital stays or of all-cause mortality through a mid-term follow-up.
Current European guidelines support transcatheter aortic valve implantation (TAVI) in intermediate-to-low-risk patients ≥75 years-old, but its prognostic relevance is unknown.
METHODS
Intermediate-to-low-risk (The Society of Thoracic Surgeons score <8%) patients enrolled in the HORSE registry were included. We compared the populations aged under 75 with those over 75. The primary endpoint was all-cause mortality.
RESULTS
A total of 2685 patients were included: 280 (8.6%) < 75 and 2405 ≥ 75 years. Through a mean follow-up of 437 ± 381 days, 198 (8.2%) and 23 (8.2%) patients died in the two arms without statistically significant differences (log-rank p = 0.925). At Cox regression analysis, age did not predict the occurrence of all-cause death, neither as a continuous variable (HR 1.01, 95% CI 0.99-1.04, p = 0.294) nor dichotomizing according to the prespecified cutoff of 75 years (HR 0.97, 95% CI 0.63-1.51, p = 0.924). Time-to-event ROC curves showed low accuracy of age to predict all-cause mortality (area under the curve of 0.54 for both 1-year and 2-year outcomes).
CONCLUSIONS
TAVI has comparable benefits across age strata for intermediate-to-low-risk patients. The age cutoff suggested by the current guidelines is not predictive of the risk of adverse events during hospital stays or of all-cause mortality through a mid-term follow-up.
Date of Publication
2024-01-22
Publication Type
Article
Subject(s)
Keyword(s)
age aortic stenosis low–intermediate risk surgical risk transcatheter aortic valve replacement
Language(s)
en
Contributor(s)
Benenati, Stefano | |
Gallo, Francesco | |
Kim, Won-Keun | |
Khokhar, Arif A | |
Zeus, Tobias | |
Toggweiler, Stefan | |
De Marco, Federico | |
Mangieri, Antonio | |
Regazzoli, Damiano | |
Reimers, Bernhard | |
Nombela-Franco, Luis | |
Barbanti, Marco | |
Regueiro, Ander | |
Piva, Tommaso | |
Rodes-Cabau, Josep | |
Porto, Italo | |
Colombo, Antonio | |
Giannini, Francesco | |
Sticchi, Alessandro |
Additional Credits
Series
Journal of cardiovascular development and disease
Publisher
MDPI
ISSN
2308-3425
Access(Rights)
open.access