High-risk admission prior to transcatheter aortic valve implantation and subsequent outcomes

Abstract

Abstract Background Severe symptomatic aortic stenosis may cause heart failure, acute myocardial infarction, or syncope; however, limited data exist on the occurrence of such events before transcatheter aortic valve implantation (TAVI) and their impact on subsequent outcomes. Purpose To investigate the association between a preceding event (hospitalization for heart failure, acute myocardial infarction, or syncope) and outcomes after TAVI. Methods Using nationwide registries, all Danish patients undergoing TAVI from 2014 through 2021 were identified. Preceding events up to 180 days before TAVI were identified. Patients were then stratified into two groups: 1) patients with a preceding event. 2) patients without a preceding event. The primary outcome of interest was 1-year risk of all-cause death estimated with Kaplan-Meier for patients with a preceding event compared with patients without. The secondary outcome of interest was 1-year cardiovascular rehospitalization amongst patients discharged alive. Here, we used Aalen-Johansen with the competing risk of death among patients alive at discharge. Finally, adjusted analyses were performed with Cox regression analyses. Results The main findings are summarized in Figure 1. The study population comprised 5,851 patients. Of these, 759 (13.0%) had a preceding event. Median age was 81 years in both groups. Frailty and male sex were more prevalent among patients with a preceding event (males: 64.7%, intermediate/high frailty: 49.6%) compared with patients without a preceding event (males: 55.2%, intermediate/high frailty 40.6%). A hospitalization for heart failure was the most common preceding event (n=524). The risk of 1-year all-cause death was 11.7% (95% CI: 9.4%–14.1%) for patients with a preceding event compared with 8.0% (95%CI: 7.2%–8-7%) for patients without a preceding event (Figure 2). This resulted in an adjusted hazard ratio of 1.29 (95%CI: 1.01–1.64). Moreover, the 1-year risk of cardiovascular rehospitalization was 15.0% (95 CI: 12.4%–17.6%) versus 8.2% (95 CI: 7.4%–8.9%) for patients with and without a preceding event (adjusted hazard ratio 1.60 [95%CI: 1.29–1.99]) (Figure 2). Conclusion A hospitalization for heart failure, acute myocardial infarction, or syncope prior to TAVI is associated with a higher risk of mortality and cardiovascular rehospitalization. These patients should be carefully evaluated prior to and after TAVI to improve outcomes.