Abstract 87: Comparative Outcomes Of TAVR In African Americans Versus Non-African Americans

Abstract

Introduction: African Americans (AA) experience more postoperative complications compared to non-African Americans (NAA) after certain procedures. Few studies compare clinical outcomes between AA and NAA post Transcatheter Aortic Valve Replacement (TAVR). Our aim is to further explore racial disparities among TAVR patients. Methods: Retrospective analysis of electronic medical records from March 2018-November 2020 of a major academic center and affiliated Veterans Affairs hospital in Chicago, IL identified all TAVR patients. Participants self-identified by race and were stratified into AA and NAA groups. The primary outcome was 3-point composite major adverse cardiac outcomes (MACE) (all cause death, myocardial infarction, cerebrovascular accident). Secondary outcomes included major differences in comorbidities, creatinine, baseline mean gradient, congestive heart failure (CHF) exacerbations, and hospital admissions. Outcomes were analyzed at 6- and 12-months post TAVR. Results: We included 151 patients in the analysis; 22% female, 65% were non-AA (44.7% white, 16.4% Hispanic, and 3.9% other) and 35% AA. They were 74 +/- 14 years old for the AA and 74 +/- 10 years old for non-AA. At 6 months (AA:15.1% v NAA:8.1%; p=.2) and at 12 months (AA:22.6% v NAA:16.2%; p=.3), there was no difference in MACE between the two populations. At 6 months post TAVR, AA were more likely to have a CHF exacerbation compared to NAA (AA:15.1% v NAA:3.1%; p=.007) despite a similar prevalence of heart failure at baseline, hypertension, hyperlipidemia, diabetes, coronary artery disease, atrial fibrillation and smoking. AA were found to have a higher baseline mean gradient when compared to NAA (AA: 36.2 v NAA:31.9 mmHg; p=.049). Creatinine at time of procedure was higher in AA when compared to NAA (Cr: 2.37 vs. 1.49 mg/dL; p=.015) and AA trended towards higher rates of end stage renal disease compared to NAA (AA:22.6% v NAA:11.1%; p=.059). Conclusion: We observed significant disparities between AA and their NAA counterparts. While both groups had similar rates of composite MACE events post TAVR at 6 and 12 months, AA tend to be a higher risk post-operative population. AA were more likely to have CHF exacerbations and were evaluated for TAVR at a later stage in their disease course.