Cancer history may not worsen TAVR outcomes
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In a systematic review and meta-analysis, a history of cancer was not associated with adverse short- and long-term outcomes in patients who had transcatheter aortic valve replacement.
“Based on these findings, TAVR should be considered in all patients with severe symptomatic [aortic stenosis], irrespective of their history of malignancy,” Alexandra C. Murphy, MBBS, BMedSci, FRACP, cardiologist at Austin Health and the University of Melbourne, Australia, and colleagues wrote in Catheterization and Cardiovascular Interventions.
The researchers included 13 studies with 10,916 patients in the systematic review and seven studies with 6,323 patients in the meta-analysis.
The coprimary outcome of long-term all-cause mortality did not significantly differ in patients with and without cancer (RR = 1.24; 95% CI, 0.95-1.63; I2 = 63%), whereas the coprimary outcome of long-term cardiac mortality was lower in those with cancer than in those without it (RR = 0.7; 95% CI, 0.51-0.96; I2 = 0%), according to the researchers. The follow-up in the seven studies included in the meta-analysis ranged from 6 to 36 months.
Short-term (30-day) all-cause mortality did not significantly differ between the groups but trended in favor of patients with cancer (RR = 0.61; 95% CI, 0.36-1.01), and there was no difference between the groups in rates of periprocedural stroke (RR = 1.07; 95% CI, 0.65-1.78), acute kidney injury (RR = 1.02; 95% CI, 0.8-1.3), bleeding (RR = 1.07; 95% CI, 0.92-1.25) and pacemaker implantation (RR = 0.99; 95% CI, 0.81-1.2), according to the researchers.
Compared with patients without cancer, patients with active cancer had higher long-term all-cause mortality (RR = 1.92; 95% CI, 1.44-2.56; I2 = 0%), but no elevated risk for short-term all-cause mortality (RR = 0.81; 95% CI, 0.45-1.45; I2 = 0%), Murphy and colleagues wrote.
The lower cardiac mortality observed in patients with a history of cancer “may reflect a degree of selection bias whereby cancer patients that were ultimately deemed suitable for TAVR by the Heart Team may have represented a lower cardiovascular risk cohort,” the researchers wrote. “As we lacked individual patient data, we were unable to assess this in this study. Regardless, the value of intervention for severe aortic stenosis is evident in this cohort.”
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