Long-Term Outcomes Worse For Smokers Following TAVR

Compared with nonsmokers, smokers have a lower in-hospital mortality rate after transcatheter aortic valve replacement (TAVR) but similar long-term survival and somewhat more long-term health problems. This puzzling difference in outcomes appears to be linked to the fact that TAVR patients who smoke often are younger than nonsmokers and have fewer comorbidities, according to a study published in the Journal of the American Heart Association.

Mohammed Qintar, MD, MSc, et al., uncovered this difference while studying the association between smoking status and outcomes following TAVR. Researchers examined the data of 72,249 TAVR patients at 457 U.S. sites who were enrolled in the STS/ACC TVT Registry between November 2011 and June 2016. The smoking status of 72,165 patients was documented. Of these patients, 3,058 were excluded because they were younger than 65 and an additional 24,887 were excluded because their data were not linked to the Centers for Medicare and  Medicaid Services.

The study found that 5.6 percent of TAVR patients (n=4,063) were recent or current smokers and that they generally presented for TAVR at a younger age than nonsmokers (75 years vs. 83 years), and they were more likely men and had a greater burden of atherosclerosis. The smokers also had greater burden of cardiovascular and lung disease. Between the smokers and nonsmokers, there were no differences in short-term outcomes for the rates of stroke or myocardial infarction.

In looking at long-term outcomes, researchers found that when compared to nonsmokers, current/recent smokers had higher one-year postdischarge mortality but this was association was lost when adjusted for patient characteristics, and a lower unadjusted and adjusted Kansas City Cardiomyopathy Questionnaire-Overall Summary Score. Smokers who survived one year after having a TAVR procedure had slightly worse heart failure-related symptoms, function and quality of life compared with nonsmokers. This led researchers to speculate on the causes of poorer outcomes for smokers following TAVR.

"[The difference in outcomes] indicates the smoking itself is not associated with strikingly different outcomes, but that the comorbidities associated with the smoking, e.g., home oxygen use and peripheral artery disease (requiring alternative access for TAVR), likely make put these patients at higher risk," researchers concluded.

Keywords: Registries, National Cardiovascular Data Registries, STS/ACC TVT Registry, Transcatheter Aortic Valve Replacement, Hospital Mortality, Peripheral Arterial Disease, Smoke, Smoking, Quality of Life, Medicaid, Centers for Medicare and Medicaid Services, U.S., Medicare, Stroke, Comorbidity, Heart Failure, Lung Diseases, Cardiomyopathies, Oxygen

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