Mortality, stroke rates after TAVR do not vary by age at 2 years
At 2 years following transcatheter aortic valve replacement, nonagenarians experienced no greater risk for mortality or stroke than younger patients, despite being at greater surgical risk, researchers reported.
However, nonagenarians had greater prevalence of HF readmission than younger patients, according to the researchers.
Additionally, sex, chronic kidney disease and frailty were all identified as independent risk factors for 2-year mortality.
According to research from the OCEAN-TAVI registry published in Catheterization and Cardiovascular Interventions, investigators determined the 30-day and 2-year clinical outcomes in patients aged at least 90 years (74% women; 12% with diabetes) who underwent TAVR compared with those younger than 90 years (69% women; 23% with diabetes) and identified predictors for 2-year mortality.
At 30 days, researchers observed no differences among nonagenarians and younger patients for mortality (2.7% vs. 1.6%, respectively; P = .15), stroke (2.7% vs. 2.1%, respectively; P = .5) or hospital readmission for HF (0.3% vs. 1%, respectively; P = .17).
At 2 years, patients aged at least 90 years who underwent TAVR experienced similar mortality compared with patients younger than 90 years (22% vs. 17.3%, respectively; P = .11) and occurrence of stroke (5.5% vs. 3.9%, respectively; P = .31), but had greater risk for HF readmission (13.3% vs. 9%; P = .03).
“The result from OCEAN-TAVI registry suggested that TAVI in selected nonagenarians has demonstrated similar excellent short-term and midterm outcomes except for heart failure readmission compared with TAVI in younger patients despite their higher operative risk,” Masahiko Noguchi, MD, of the department of cardiology at Tokyo Bay Urayasu Ichikawa Medical Center, Japan, and colleagues wrote. “Advanced age was not an independent predictor for midterm clinical outcomes, suggesting that TAVI should not be denied only by advanced age.”
Independent risk factors for 2-year mortality in nonagenarians after TAVR included female sex (HR = 0.43; 95% CI, 0.26-0.74), Clinical Frailty Scale score of 4 or greater (HR = 1.82; 95% CI, 1.02-3.42) and chronic kidney disease with estimated glomerular filtration rate less than 30 mL/min/1.73 m2 (HR = 2.14; 95% CI, 1.21-3.64).
“Better outcomes might be just because of better preprocedural status, which also means better patient selection. Careful patient selection is essential for invasive treatment in very old patients,” the researchers wrote. “Additionally, the average life expectancy at age of 90 in Japan was 4.3 years for men and 5.6 years for women in 2017. This long-life expectancy of Japanese nonagenarians might have contributed to this excellent survival outcome.” – by Scott Buzby
Disclosures: Noguchi reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.