Short- and Long-Term Mortality and Stroke Risk After Transcatheter Aortic Valve Implantation

TY - JOUR

T1 - Short- and Long-Term Mortality and Stroke Risk After Transcatheter Aortic Valve Implantation

AU - Jakobsen, Lars

AU - Terkelsen, Christian J

AU - Søndergaard, Lars

AU - De Backer, Ole

AU - Aarøe, Jens

AU - Nissen, Henrik

AU - Johnsen, Søren P

AU - Christiansen, Evald H

N1 - Copyright © 2017 Elsevier Inc. All rights reserved.

PY - 2018/1/1

Y1 - 2018/1/1

N2 - No published studies have compared the outcome after transcatheter aortic valve implantation (TAVI) with the outcome in the general population. Thus, it is unknown whether TAVI restores normal life expectancy and stroke risk. Furthermore, despite the increasing use of TAVI, only little is known about the temporal trends for TAVI regarding patient characteristics and outcomes. We identified all Danish patients treated with TAVI from 2006 to 2014 (n = 1,631) and 9,737 general population controls matched by gender, age, and co-morbidity. The primary end point was a composite end point of all-cause mortality and stroke. During the first 90 days, the risk of the combined end point, the stroke risk, and mortality were significantly higher among TAVI patients compared with controls (9.4%, 7.5%, and 2.5%, respectively, in TAVI patients compared with 2.0%, 1.6%, and 0.5% in controls). After 90 days, there were no differences (adjusted mortality rate ratio, stroke rate ratio, and mortality or stroke rate ratio 0.92 [0.79 to 1.06], 1.32 [0.98 to 1.78], and 1.00 [0.90 to 1.10], respectively). During the study period, there were small changes in the characteristics of patients treated with TAVI; however, more patients were treated by transfemoral access; fewer needed blood transfusions, hospital stays were shorter, and the overall mortality rate decreased. In conclusion, 90 days after TAVI, the stroke risk and mortality of the TAVI patients were comparable with the stroke risk and mortality of the general population. Over time, the patient risk profiles have remained largely unchanged; however, outcomes have improved substantially, including lower short- and long-term mortality.

AB - No published studies have compared the outcome after transcatheter aortic valve implantation (TAVI) with the outcome in the general population. Thus, it is unknown whether TAVI restores normal life expectancy and stroke risk. Furthermore, despite the increasing use of TAVI, only little is known about the temporal trends for TAVI regarding patient characteristics and outcomes. We identified all Danish patients treated with TAVI from 2006 to 2014 (n = 1,631) and 9,737 general population controls matched by gender, age, and co-morbidity. The primary end point was a composite end point of all-cause mortality and stroke. During the first 90 days, the risk of the combined end point, the stroke risk, and mortality were significantly higher among TAVI patients compared with controls (9.4%, 7.5%, and 2.5%, respectively, in TAVI patients compared with 2.0%, 1.6%, and 0.5% in controls). After 90 days, there were no differences (adjusted mortality rate ratio, stroke rate ratio, and mortality or stroke rate ratio 0.92 [0.79 to 1.06], 1.32 [0.98 to 1.78], and 1.00 [0.90 to 1.10], respectively). During the study period, there were small changes in the characteristics of patients treated with TAVI; however, more patients were treated by transfemoral access; fewer needed blood transfusions, hospital stays were shorter, and the overall mortality rate decreased. In conclusion, 90 days after TAVI, the stroke risk and mortality of the TAVI patients were comparable with the stroke risk and mortality of the general population. Over time, the patient risk profiles have remained largely unchanged; however, outcomes have improved substantially, including lower short- and long-term mortality.

KW - Aged

KW - Aged, 80 and over

KW - Aortic Valve Stenosis/mortality

KW - Case-Control Studies

KW - Denmark/epidemiology

KW - Female

KW - Humans

KW - Male

KW - Postoperative Complications/epidemiology

KW - Risk Factors

KW - Stroke/epidemiology

KW - Survival Rate

KW - Transcatheter Aortic Valve Replacement/adverse effects

U2 - 10.1016/j.amjcard.2017.09.014

DO - 10.1016/j.amjcard.2017.09.014

M3 - Journal article

C2 - 29103605

SN - 0002-9149

VL - 121

SP - 78

EP - 85

JO - Am. J. Cardiol.

JF - Am. J. Cardiol.

IS - 1

ER -