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. 2023 Mar 8;2(2):100255.
doi: 10.1016/j.jacadv.2023.100255. eCollection 2023 Mar.

Outcomes of Transcatheter Aortic Valve Replacement in Patients With Coexisiting Amyloidosis: Mortality, Stroke, and Readmission

Mohammed Elzeneini  1 , Shishir Gupta  2 , Yazan Assaf  3 , Dharam J Kumbhani  4 , Khanjan Shah  1 , Justin L Grodin  4 , Anthony A Bavry  4
Affiliations

Outcomes of Transcatheter Aortic Valve Replacement in Patients With Coexisiting Amyloidosis: Mortality, Stroke, and Readmission

Mohammed Elzeneini et al. JACC Adv. .

Abstract

Background: Cardiac amyloidosis can coexist in patients with severe aortic stenosis. There are limited outcomes data on whether this impacts the risk of transcatheter aortic valve replacement (TAVR).

Objectives: The authors aimed to investigate the effect of amyloidosis on outcomes of TAVR.

Methods: We 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.

Results: We 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: 3.08, 95% CI: 1.41-6.71, P = 0.005), but no difference in mortality (odds ratio: 0.79, 95% CI: 0.28-2.27, P = 0.666) or 30-day readmission rate after TAVR (HR: 0.72, 95% CI: 0.41-1.25, P = 0.241).

Conclusions: This analysis suggests amyloidosis may be associated with a higher thromboembolic risk after TAVR that merits further investigation.

Keywords: amyloidosis; stroke; transcatheter aortic valve replacement.

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Conflict of interest statement

Dr Grodin is a consultant for Pfizer, Alnylam, Eidos and Sarepta; and has received research support from Eidos and the Texas Health Resources Clinical Scholarship. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.PERSPECTIVESCOMPETENCY IN PATIENT CARE: In this nationwide observational analysis, TAVR in dual AS-amyloidosis pathology was associated with a higher risk of acute ischemic stroke after TAVR compared to lone AS. There was no difference in in-hospital mortality or 30-day readmission rates. TRANSLATIONAL OUTLOOK: The observed higher risk of stroke highlights the potential for greater thromboembolic risk after TAVR that deserves to be further studied.

Figures

None
Graphical abstract
Figure 1
Figure 1
Flow Diagram of Study Population Flow diagram of primary cohort for analysis of in-hospital outcomes and secondary cohort for analysis of 30-day readmission rates. NRD = Nationwide Readmissions Database; TAVR = transcatheter aortic valve replacement.
Figure 2
Figure 2
Association of Amyloidosis With Outcomes After TAVR Association of amyloidosis with in-hospital outcomes and 30-day readmission rate after TAVR. Propensity score-weighted logistic regression analysis was used to generate OR for in-hospital outcomes, and Cox proportional hazards regression analysis was used to generate a HR for 30-day readmission rate.
Central Illustration
Central Illustration
Procedural Outcomes After TAVR in Dual Aortic Stenosis-AmyloidosisPathology
See this image and copyright information in PMC

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