Age elevates mortality, stroke, pacemaker implantation risk after TAVR
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Risk for mortality, stroke and permanent pacemaker implantation after transcatheter aortic valve replacement increased with age, according to new data from the SwissTAVI Registry.
The researchers compared clinical outcomes after TAVR in 324 patients younger than 70 years, 1,913 patients aged 70 to 79 years, 4,353 patients aged 80 to 89 years and 507 patients aged 90 years or older. The overall cohort consisted of 7,097 patients (mean age, 82 years; 50% women) who underwent TAVR at 15 hospitals in Switzerland from February 2011 to June 2018.
Although procedural characteristics were similar across age groups, older patients were less likely to be discharged home than younger patients (P for trend < .001), Adrian Attinger-Toller, MD, interventional cardiologist at University and Hospital Fribourg, Switzerland, and colleagues wrote.
After adjustment, increasing age was associated with the following outcomes:
- 30-day mortality (adjusted HR = 1.45; 95% CI, 1.18-1.77);
- 1-year mortality (aHR = 1.12; 95% CI, 1.01-1.24);
- cerebrovascular accidents at 30 days (aHR = 1.35; 95% CI, 1.09-1.66);
- cerebrovascular accidents at 1 year (aHR = 1.21; 95% CI, 1.02-1.45);
- pacemaker implantation at 30 days (aHR = 1.23; 95% CI, 1.12-1.34), and
- pacemaker implantation at 1 year (aHR = 1.19; 95% CI, 1.09-1.3).
The standardized mortality ratios for the cohort were higher than for the general Swiss population matched for age and sex in those younger than 70 years (12.63; 95% CI, 9.06-17.58), 70 to 79 years (4.09; 95% CI, 3.56-4.74) and 80 to 89 years (1.63; 95% CI, 1.5-1.78), but not in those aged 90 years or older (0.93; 95% CI, 0.76-1.14), according to the researchers.
“Valvular heart disease and associated comorbidities were associated with a significant increase in mortality at 1 year for TAVR patients below the age of 90 years compared with the general population, following a significant trend across age groups. Interestingly, patients above the age of 90 years had similar outcomes and TAVR was able to restore life expectancy in this patient population when compared with the general population,” Attinger-Toller and colleagues wrote.
“The present SwissTAVI analysis suggests that although there appears to be a linear trend in mortality with age, standardized mortality ratios were incrementally higher in younger patients compared with expected rates in age- and sex-matched Swiss population,” Ricardo O. Escárcega, MD, and Brian Hummel, MD, both from Lee Health System in Fort Myers, Florida, wrote in a related editorial. “It provides a strong argument that in the general population age alone should not be definitive inclusion or exclusion criteria.”
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