Minimally symptomatic patients likely to survive with good health status after TAVR
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Key takeaways:
- People with minimally symptomatic status before TAVR tend to do better at 1 year than those who were more symptomatic.
- Baseline health status appears to be prognostic for outcomes after TAVR.
Patients with minimally symptomatic status who underwent transcatheter aortic valve replacement were more likely to survive with good health status at 1 year than more symptomatic patients, researchers reported.
However, those with minimally symptomatic status had smaller improvements in health status after TAVR compared with more symptomatic patients.
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Chetan P. Huded, MD, MSc, interventional cardiologist and medical director of the left atrial appendage closure program at Saint Luke’s Mid America Heart Institute and clinical scholar and assistant professor of medicine at the University of Missouri – Kansas City, and colleagues analyzed the outcomes of 231,285 patients with severe aortic stenosis included in the Society of Thoracic Surgeons/American College of Cardiology Transcatheter Valve Therapeutics registry who underwent TAVR from 2015 to 2021 (median age, 80 years; 47.5% women), of whom 20% had minimally symptomatic status, defined as a Kansas City Cardiomyopathy Questionnaire Overall Summary (KCCQ-OS) score of 75 or more, at baseline.
“There is growing interest in earlier timing of TAVR,” Huded and colleagues wrote. “A key insight needed to better understand the risks and benefits of this approach is a deeper understanding of the outcomes of TAVR in asymptomatic or minimally symptomatic patients with severe aortic stenosis.”
Lower risk with minimal symptoms
Compared with those with moderate or severe symptoms, those with minimal symptoms had reduced risk for death at 1 year (adjusted HR = 0.7; 95% CI, 0.66-0.75) and were more likely to survive with good health status at 1 year (aOR = 1.19; 95% CI, 1.16-1.23), according to the researchers.
In those with minimally symptomatic status at baseline, the mean KCCQ-OS score improved by 2.7 points (95% CI, 2.6-2.9) at 30 days and 3.8 points (95% CI, 3.6-4) at 1 year, which was lower than the improvements in more symptomatic patients (30 days, 32.2 points; 95% CI, 32-32.3; 1 year, 34.9 points; 95% CI, 34.7-35), the researchers wrote.
“These findings extend the existing literature on the prognostic value of baseline health status before TAVR,” Huded and colleagues wrote.
Actually helping patients
In a related editorial, Charanjit S. Rihal, MD, MBA, consultant in the department of cardiovascular medicine and professor of medicine at Mayo Clinic in Rochester, Minnesota, wrote: “The data show we are likely not hurting patients by providing TAVR to minimally symptomatic patients, but that is not enough. We need to demonstrate we are actually helping them. There are good theoretical reasons for thinking we are: possibly a lower risk of sudden death, we can clear patients to exercise, and so on, but we can’t claim we are helping them unless we can prove it.”
A randomized controlled trial is the way to determine whether TAVR is helping these patients, and “the investigators also demonstrate there are more than enough patients to conduct such a study, and to conduct it rapidly,” Rihal wrote.
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