AF more than doubled 1-year mortality among TAVR recipients

Atrial fibrillation of any type was associated with more than a twofold increased risk for all-cause and CV mortality among patients undergoing transcatheter aortic valve replacement at 1 year, study results found.

To assess the effect of AF on clinical outcomes among patients undergoing TAVR, researchers enrolled 389 high-risk patients into a prospective registry from August 2007 and October 2011.

AF was recorded in 131 patients (33.7%) with a mean CHA₂DS₂–VASC score of 4.5 ± 1.2. Types of AF included paroxysmal in 26 (25%), persistent in eight (7.7%) and permanent in 70 patients (67.3%).

At 1 year, all-cause mortality was higher among patients with AF compared with those without AF (HR=2.36; 95% CI, 1.43-3.9). A higher risk for all-cause mortality existed regardless 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).

Among high-risk TAVR patients with severe aortic stenosis, the degree of risk directly correlated with the CHA₂DS₂–VASC score.

Mortality gradually increased with higher CHA₂DS₂–VASC scores (score 1-3, HR=2.20; 95% CI, 0.92 to 5.27; score 6-8, HR=4.12; 95% CI, 2.07-8.20). Risks for stroke (3.9% vs. 5.1%; HR=0.76; 95% CI, 0.23- 1.96) and life-threatening bleeding (19.8% vs. 14.7%; HR=1.37; 95% CI, 0.86-2.19) were similar among patients regardless of the presence of AF.

“The CHADS₂- and more recently the CHA₂DS₂–VASC score provide a reliable risk stratification for cerebrovascular events in patients with AF,” the researchers wrote.

Disclosure: Stortecky reports no relevant financial disclosures.

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Source: Stortecky S. Circ Cardiovasc Interv. 2013;doi:10.1161/circinterventions.112.000124.