AI Article Synopsis

  • Current European guidelines recommend TAVI for patients aged 75 and older, but its effectiveness based on age is uncertain.
  • In a study of 2,685 intermediate-to-low-risk patients, mortality rates at a mean follow-up of 437 days were similar for those under and over 75 years old.
  • The findings indicate that age does not significantly predict all-cause mortality for TAVI patients, suggesting that the age threshold in guidelines may not accurately reflect risk.

Article Abstract

Background: Current European guidelines support transcatheter aortic valve implantation (TAVI) in intermediate-to-low-risk patients ≥75 years-old, but its prognostic relevance is unknown.

Methods: Intermediate-to-low-risk (The Society of Thoracic Surgeons score <8%) patients enrolled in the HORSE registry were included. We compared the populations aged under 75 with those over 75. The primary endpoint was all-cause mortality.

Results: A total of 2685 patients were included: 280 (8.6%) < 75 and 2405 ≥ 75 years. Through a mean follow-up of 437 ± 381 days, 198 (8.2%) and 23 (8.2%) patients died in the two arms without statistically significant differences (log-rank = 0.925). At Cox regression analysis, age did not predict the occurrence of all-cause death, neither as a continuous variable (HR 1.01, 95% CI 0.99-1.04, = 0.294) nor dichotomizing according to the prespecified cutoff of 75 years (HR 0.97, 95% CI 0.63-1.51, = 0.924). Time-to-event ROC curves showed low accuracy of age to predict all-cause mortality (area under the curve of 0.54 for both 1-year and 2-year outcomes).

Conclusions: TAVI has comparable benefits across age strata for intermediate-to-low-risk patients. The age cutoff suggested by the current guidelines is not predictive of the risk of adverse events during hospital stays or of all-cause mortality through a mid-term follow-up.

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Source
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC10816002PMC
http://dx.doi.org/10.3390/jcdd11010033DOI Listing

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