Certain cancers linked to elevated readmission, bleeding risk after TAVR
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Key takeaways:
- Active cancer during TAVR was not associated with risk for in-hospital mortality.
- Certain subtypes, including colon, prostate and metastatic cancers, were tied to hospital readmission and bleeding risk.
Active cancer during transcatheter aortic valve replacement did not increase in-hospital mortality, but certain cancer types were tied to elevated rehospitalization and major bleeding risk in the following months, researchers reported.
Cancers associated with readmission after TAVR included colon and metastatic cancers and those tied to bleeding requiring transfusion included colon, metastatic and prostate cancers, according to data published in the Journal of the American Heart Association.
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“Among various cancers, colon cancer may be associated with a significant risk of postprocedural bleeding after TAVR, as with percutaneous coronary intervention for acute myocardial infarction. On the other hand, active cancer is known to increase thrombotic events given its hypercoagulable state. Recent retrospective studies have suggested no significant differences in all-cause mortality at 30 days between patients with or without active cancer,” Tadao Aikawa, MD, PhD, of the department of cardiology at Juntendo University Urayasu Hospital in Urayasu, Japan, and the department of radiology at Jichi Medical University Saitama Medical Center in Saitama, Japan, and colleagues wrote. “However, data on clinical outcomes after TAVR in specific cancer types or the presence of metastatic disease remain sparse. This study aimed to investigate the impact of active cancer on short-term mortality, complications and midterm readmissions after TAVR across different cancer types.”
Using the Nationwide Readmissions Database, developed for the Healthcare Cost and Utilization Project in the U.S., Aikawa and colleagues identified 122,573 patients who underwent TAVR from 2012 to 2019 (mean age, 80 years) and stratified them by cancer subtypes.
The primary outcome was in-hospital mortality. Secondary outcomes included bleeding requiring blood transfusion and readmission 30, 90 and 180 days after TAVR.
In-hospital mortality with active cancer
Overall, 6.5% of the cohort had active cancer, of whom 215 had colon cancer, 451 had lung cancer, 863 had prostate cancer, 382 had breast cancer and 554 had metastatic cancer.
Presence of active cancer at the time of TAVR was not associated with increased likelihood of the primary outcome compared with no cancer (adjusted OR = 1.06; 95% CI, 0.89-1.27; P = .523); however, active cancer was associated with an increased risk for readmission at 30 days (13.3% vs. 16.8%; P < .001), 90 days (22.5% vs. 29.8%; P < .001) and 180 days after TAVR (30.8% vs. 40.1%; P < .001) and increased risk for bleeding requiring transfusion (P at all three timepoints < .001).
Colon cancer and any metastatic cancer subtype were both independently associated with 30-, 90- and 180-day readmission after TAVR compared with no cancer, according to the study.
Moreover, colon cancer (aOR = 2.51; 95% CI, 1.68-3.76; P < .001), prostate cancer (aOR = 1.4; 95% CI, 1.05-1.86; P = .021) and any type of metastatic cancer (aOR = 1.65; 95% CI, 1.23-2.22; P = .001) were each independently associated with risk for bleeding requiring transfusion at 30 days after TAVR.
‘Multidisciplinary cardio-oncology approach’ needed
“There is no standardized TAVR protocol for patients with active cancer, including the type of valve used, the necessity and duration of antithrombotic therapy, anesthesia during TAVR and cancer therapies after TAVR,” the researchers wrote. “Given the complexity in the management of patients with severe aortic stenosis and high risks of bleeding complications and readmission after TAVR found in this study, a multidisciplinary cardio-oncology approach will be needed to optimize these patient outcomes.”
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