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. 2022 May 2:40:101045.
doi: 10.1016/j.ijcha.2022.101045. eCollection 2022 Jun.

Prognosis of patients with active cancer undergoing transcatheter aortic valve implantation: An insight from Japanese multicenter registry

Yoshimasa Kojima  1   2 , Ryosuke Higuchi  1 , Kenichi Hagiya  1 , Mike Saji  1 , Itaru Takamisawa  1 , Nobuo Iguchi  1 , Shuichiro Takanashi  3 , Shinichiro Doi  4 , Shinya Okazaki  4 , Kei Sato  5 , Harutoshi Tamura  6 , Morimasa Takayama  1 , Takanori Ikeda  2 , Mitsuaki Isobe  1
Affiliations

Prognosis of patients with active cancer undergoing transcatheter aortic valve implantation: An insight from Japanese multicenter registry

Yoshimasa Kojima et al. Int J Cardiol Heart Vasc. .

Abstract

Background: Malignancy is common in older adults undergoing transcatheter aortic valve implantation (TAVI), and may affect prognosis. The present study aimed to examine whether active cancer affects all-cause mortality rates among patients undergoing TAVI.

Methods: This retrospective study examined data from 1,114 consecutive patients treated between April 2010 and June 2019. Patients with life expectancy of <1 year due to non-cardiac causes were excluded.

Results: Active cancer was defined as cancer under treatment or cured within 1 year, and was recognized in 62 patients (5.6%) with (n = 17) and without (n = 45) metastases. In multivariate analysis, being female (hazard ratio [HR] 0.55, 95% confidence interval [CI] 0.39-0.77, p < 0.001), body mass index (BMI) (HR = 0.92 per 1 kg/m2 increase, 95% CI 0.87-0.97, p = 0.001), New York Heart Association (NYHA) class III/IV (HR = 1.53, 95% CI 1.06-2.20, p = 0.022), atrial fibrillation (HR = 2.40, 95% CI 1.70-3.38, p < 0.001), albumin levels (HR = 0.41 per 1-g/dl, 95% CI 0.30-0.57, p < 0.001), and cancer metastasis (HR = 5.28, 95% CI 1.86-14.9, p = 0.001) were associated with all-cause mortality after TAVI.

Conclusion: In patients undergoing TAVI, being female, high BMI, NYHA class III/IV, atrial fibrillation, albumin levels, and cancer metastasis were factors associated with mortality. Meanwhile, active cancer without metastasis was not associated with increased mortality rates. These findings would help clinical decision-making by patients and physicians.Clinical trial registration: UMIN000031133.

Keywords: AS, aortic stenosis; CI, confidence interval; CT, computed tomography; Cancer; Carcinoma; HR, hazard ratio; Malignancy; Mortality; NYHA, New York Heart Association; SAVR, surgical aortic valve replacement; TAVI, transcatheter aortic valve implantation; Transcatheter aortic valve replacement.

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Conflict of interest statement

Dr Takamisawa is a clinical proctor of Edwards Lifesciences and Medtroic. The other authors have no conflict of interest regarding this article.

Figures

Fig. 1
Fig. 1
. Treatment policy of patients with active cancer. Therapy aiming to extend survival was defined as radical therapy, and that aiming to alleviate symptoms was defined as palliative therapy.
Fig. 2
Fig. 2
. Patient survival estimates, stratified by cancer status: non-metastatic cancer vs. metastatic cancer vs. non-cancer group. TAVI indicates transcatheter aortic valve implantation.
See this image and copyright information in PMC

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