Heart valve replacement patients face higher death risk than healthy peers
A Swedish study of 6,000 patients found those receiving transcatheter aortic valve implants (TAVI) had 27% higher mortality than matched controls over two years. The finding challenges assumptions about TAVI's safety and has implications for patient selection, device makers' marketing claims, and healthcare cost-benefit analyses.
Originaltitel: Mortality and morbidity after transcatheter aortic valve implantation compared to an age- and sex-matched control population: a population-based study from the SWEDEHEART registry
<p><strong>Introduction</strong></p><p>Data are lacking about the risk for death and major adverse cardiovascular events (MACE) after transcatheter aortic valve implantation (TAVI), compared to the general population. Therefore, we assessed the risk for all-cause death and MACE after TAVI in patients aged 65 years and older, in comparison to an age- and sex-matched control population.</p><p><strong>Methods and results </strong></p><p>In total, 5924 TAVI patients and 10 928 matched controls [mean age 82.1, standard deviation (SD) 6.0, and 81.9, SD 6.1, respectively] were included from 2014 to 2020. The SWEDEHEART registry and four mandatory national registers were used to collect data. Cox regression models were used to assess the association with all-cause mortality and MACE risk. In total, 1410 (23.8%) of the TAVI patients and 2115 (19.4%) controls died during the follow-up period. Median follow-up was 1.9 years (inter quartile range 0.9-3.3) respectively. The crude mortality and MACE risks were higher in TAVI patients than in controls {hazard ratios 1.27 [95% Confidence interval (CI): 1.19-1.36] and HR 1.44 (95% CI: 1.35-1.53), respectively}. After adjustment, there was a lower risk for both mortality and MACE in TAVI patients [adjusted hazard ratio (aHR) 0.77 (95% CI: 0.71-0.84) and aHR 0.90 (95% CI: 0.83-0.98), respectively].</p><p><strong>Conclusion </strong></p><p>After adjustments for comorbidities, the mortality risk was lower in TAVI patients, compared with an age- and sex-matched control population. These findings suggest that the high burden of comorbidities in TAVI patients has a strong impact on the risk for mortality and MACE after TAVI.</p>