TY - JOUR
T1 - Outcomes of Transcatheter Aortic Valve Replacement in Patients With Coexisiting Amyloidosis
T2 - Mortality, Stroke, and Readmission
AU - Elzeneini, Mohammed
AU - Gupta, Shishir
AU - Assaf, Yazan
AU - Kumbhani, Dharam J.
AU - Shah, Khanjan
AU - Grodin, Justin L.
AU - Bavry, Anthony A.
N1 - Publisher Copyright:
© 2023 The Authors
PY - 2023/3
Y1 - 2023/3
N2 - Background: Cardiac amyloidosis can coexist in patients with severe aortic stenosis. There are limited outcomes data on whether this impacts the risk of transcatheter aortic valve replacement (TAVR). Objectives: The authors aimed to investigate the effect of amyloidosis on outcomes of TAVR. Methods: We used the Nationwide Readmissions Database to identify hospitalizations for TAVR between 2016 and 2019. The presence of a diagnosis of amyloidosis was identified. Propensity score-weighted regression analysis was used to identify the association of amyloidosis with in-hospital mortality, acute ischemic stroke, and 30-day readmission rate after TAVR. Results: We identified 245,020 hospitalizations for TAVR, including 273 in patients with amyloidosis. The mean age was 79.4 ± 8.4 years. There was no difference in in-hospital mortality or 30-day readmission rate in patients with and without amyloidosis (1.8% vs 1.5%, P = 0.622; and 12.9% vs 12.5%, P = 0.858; respectively). However, there was a higher rate of acute ischemic stroke in patients with amyloidosis (6.2% vs 1.8%, P < 0.001). Propensity score-weighted logistic regression analysis showed the presence of amyloidosis was associated with greater odds of acute ischemic stroke (odds ratio: 3.08, 95% CI: 1.41-6.71, P = 0.005), but no difference in mortality (odds ratio: 0.79, 95% CI: 0.28-2.27, P = 0.666) or 30-day readmission rate after TAVR (HR: 0.72, 95% CI: 0.41-1.25, P = 0.241). Conclusions: This analysis suggests amyloidosis may be associated with a higher thromboembolic risk after TAVR that merits further investigation.
AB - Background: Cardiac amyloidosis can coexist in patients with severe aortic stenosis. There are limited outcomes data on whether this impacts the risk of transcatheter aortic valve replacement (TAVR). Objectives: The authors aimed to investigate the effect of amyloidosis on outcomes of TAVR. Methods: We used the Nationwide Readmissions Database to identify hospitalizations for TAVR between 2016 and 2019. The presence of a diagnosis of amyloidosis was identified. Propensity score-weighted regression analysis was used to identify the association of amyloidosis with in-hospital mortality, acute ischemic stroke, and 30-day readmission rate after TAVR. Results: We identified 245,020 hospitalizations for TAVR, including 273 in patients with amyloidosis. The mean age was 79.4 ± 8.4 years. There was no difference in in-hospital mortality or 30-day readmission rate in patients with and without amyloidosis (1.8% vs 1.5%, P = 0.622; and 12.9% vs 12.5%, P = 0.858; respectively). However, there was a higher rate of acute ischemic stroke in patients with amyloidosis (6.2% vs 1.8%, P < 0.001). Propensity score-weighted logistic regression analysis showed the presence of amyloidosis was associated with greater odds of acute ischemic stroke (odds ratio: 3.08, 95% CI: 1.41-6.71, P = 0.005), but no difference in mortality (odds ratio: 0.79, 95% CI: 0.28-2.27, P = 0.666) or 30-day readmission rate after TAVR (HR: 0.72, 95% CI: 0.41-1.25, P = 0.241). Conclusions: This analysis suggests amyloidosis may be associated with a higher thromboembolic risk after TAVR that merits further investigation.
KW - amyloidosis
KW - stroke
KW - transcatheter aortic valve replacement
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U2 - 10.1016/j.jacadv.2023.100255
DO - 10.1016/j.jacadv.2023.100255
M3 - Article
AN - SCOPUS:85161589552
SN - 2772-963X
VL - 2
JO - JACC: Advances
JF - JACC: Advances
IS - 2
M1 - 100255
ER -