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Outcomes of TAVR in Patients With Coexisting Amyloidosis
Quick Takes
- There was no difference in in-hospital mortality or 30-day readmission rate after TAVR in patients with severe aortic stenosis (AS) and amyloidosis, compared to patients with lone AS.
- The presence of amyloidosis was, however, associated with an approximate threefold greater odds of developing acute ischemic stroke during hospitalization.
- This suggests a potential association with a higher thromboembolic risk after TAVR that merits further research.
Study Questions:
What is the effect of amyloidosis on outcomes of transcatheter aortic valve replacement (TAVR)?
Methods:
The investigators 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. Matching was done using Kernel matching, where every subject was matched with the weighted average of control subjects, followed by logistic regression analysis.
Results:
The authors 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 [OR], 3.08; 95% confidence interval [CI], 1.41-6.71; p = 0.005), but no difference in mortality (OR, 0.79; 95% CI, 0.28-2.27; p = 0.666) or 30-day readmission rate after TAVR (hazard ratio, 0.72; 95% CI, 0.41-1.25; p = 0.241).
Conclusions:
The authors report that amyloidosis may be associated with a higher thromboembolic risk after TAVR that merits further investigation.
Perspective:
This observational analysis of TAVR hospitalizations in patients with severe AS and a concomitant diagnosis of amyloidosis found no difference in in-hospital mortality or 30-day readmission rate after TAVR compared to patients with lone AS. The presence of amyloidosis was, however, associated with an approximate threefold greater odds of developing acute ischemic stroke during hospitalization. This suggests a potential association with a higher thromboembolic risk after TAVR that merits further investigation. Additional studies are also indicated to assess whether medical therapy with TTR stabilizers or therapies that suppress TTR production in patients with transthyretin cardiac amyloidosis (ATTR-CA) would impact/mitigate their periprocedural stroke risk.
Clinical Topics: Cardiac Surgery, Geriatric Cardiology, Heart Failure and Cardiomyopathies, Invasive Cardiovascular Angiography and Intervention, Prevention, Valvular Heart Disease, Aortic Surgery, Cardiac Surgery and Arrhythmias, Cardiac Surgery and Heart Failure, Cardiac Surgery and VHD, Acute Heart Failure, Interventions and Structural Heart Disease, Interventions and Vascular Medicine
Keywords: Amyloidosis, Aortic Valve Stenosis, Cardiac Surgical Procedures, Geriatrics, Heart Failure, Heart Valve Diseases, Ischemic Stroke, Patient Readmission, Prealbumin, Secondary Prevention, Stroke, Thromboembolism, Transcatheter Aortic Valve Replacement
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