Author + information
- Received November 26, 2018
- Revision received February 1, 2019
- Accepted February 19, 2019
- Published online May 20, 2019.
- Wieneke Vlastra, MDa,
- Jaya Chandrasekhar, MBBS, MSa,b,
- Jeroen Vendrik, MDa,
- Enrique Gutierrez-Ibanes, MD, PhDc,
- Didier Tchétché, MDd,
- Fabio S. de Brito Jr., MD, PhDe,
- Marco Barbanti, MDf,
- Ran Kornowski, MDg,
- Azeem Latib, MDh,
- Augusto D’Onofrio, MD, PhDi,
- Flavio Ribichini, MD, PhDj,
- Jan Baan, MD, PhDa,
- Jan G.P. Tijssen, PhDa,
- Manuel Pan, MD, PhDk,
- Nicolas Dumonteil, MDd,
- José A. Mangione, MD, PhDl,
- Samantha Sartori, PhDb,
- Paola D’Errigo, MScm,
- Giuseppe Tarantini, MD, PhDn,
- Mattia Lunardi, MDj,
- Katia Orvin, MDg,
- Matteo Pagnesi, MDh,
- Joaquin Sanchez Gila, MDo,
- Thomas Modine, MDp,
- George Dangas, MD, PhDb,
- Roxana Mehran, MDb,
- Jan J. Piek, MD, PhDa and
- Ronak Delewi, MD, PhDa,∗ ()
- aHeart Center, Department of Clinical and Experimental Cardiology, Amsterdam UMC, University of Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam, the Netherlands
- bZena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York
- cDepartment of Cardiology, Instituto de Investigación Sanitaria Gregorio Marañón, Centro de Investigación Biomédica en Red Enfermedades Cardiovasculares, Madrid, Spain
- dClinique Pasteur, Toulouse, France
- eHeart Institute (InCor), University of São Paulo Medical School, São Paulo, Brazil
- fDivision of Cardiology, Policlinico-Vittorio Emanuele Hospital, University of Catania, Catania, Italy
- gCardiology Department, Rabin Medical Center, Petach Tikva, Israel
- hInterventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy
- iDivision of Cardiac Surgery, Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, Italy
- jDivision of Cardiology, Department of Medicine, University of Verona, Verona, Italy
- kUnidad de Cardiología Intervencionista, Hospital Universitario Reina Sofía, Universidad de Córdoba, Instituto Maimónides para la Investigación en Biomedicina de Córdoba, Córdoba, Spain
- lBeneficencia Portuguesa Hospital, Sao Paulo, Brazil
- mNational Centre for Global Health, Istituto Superiore di Sanità, Rome, Italy
- nInterventional Cardiology Unit, Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padua, Italy
- oCardiology Department, Hospital Virgen de las Nieves, Granada, Spain
- pInstitut Coeur Poumon, Centre Hospitalier Régional Universitaire de Lille, Lille, France
- ↵∗Address for correspondence:
Dr. Ronak Delewi, AMC Heart Center, Department of Cardiology, Academic Medical Center–University of Amsterdam, Meibergdreef 9, 1105AZ Amsterdam, the Netherlands.
Objectives This study aimed to compare differences in patient characteristics and clinical outcomes of nonagenarians undergoing transcatheter aortic valve replacement (TAVR) versus patients younger than 90 years of age and to test the predictive accuracy of the logistic EuroSCORE (European System for Cardiac Operative Risk Evaluation), the EuroSCORE II, and the STS-PROM (Society of Thoracic Surgeons Predicted Risk of Mortality) for mortality after TAVR in nonagenarians.
Background The prevalence of severe aortic valve stenosis is increasing due to the rising life expectancy. However, there are limited data evaluating outcomes in patients older than 90 years of age. Moreover, the predictive accuracy of risk scores for mortality has not been evaluated in nonagenarian patients undergoing transfemoral TAVR.
Methods The CENTER (Cerebrovascular EveNts in Patients Undergoing TranscathetER Aortic Valve Implantation) collaboration (N = 12,381) is an international collaboration consisting of 3 national registries, 6 local or multicenter registries, and 1 prospective clinical study, selected through a systematic online search. The primary endpoint of this study was the difference in 30-day all-cause mortality and stroke after TAVR in nonagenarians versus patients younger than 90 years of age. Secondary endpoints included differences in baseline characteristics, in-hospital outcomes, and the differences in predictive accuracy of the logistic EuroSCORE, the EuroSCORE II, and STS-PROM.
Results A total of 882 nonagenarians and 11,499 patients younger than 90 years of age undergoing transfemoral TAVR between 2007 and 2018 were included. Nonagenarians had considerably fewer comorbidities than their counterparts. Nevertheless, rates of 30-day mortality (9.9% vs. 5.4%; relative risk [RR]: 1.8; 95% confidence interval [CI]: 1.4 to 2.3; p = 0.001), in-hospital stroke (3.0% vs. 1.9%; RR: 1.5; 95% CI: 1.0 to 2.3; p = 0.04), major or life-threatening bleeding (8.1% vs. 5.5%; RR: 1.6; 95% CI: 1.1 to 2.2; p = 0.004), and new-onset atrial fibrillation (7.9% vs. 5.2%; RR: 1.6; 95% CI: 1.1 to 2.2; p = 0.01) were higher in nonagenarians. The STS-PROM adequately estimated mortality in nonagenarians, with an observed-expected mortality ratio of 1.0.
Conclusions In this large, global, patient-level analysis, mortality after transfemoral TAVR was 2-fold higher in nonagenarians compared with patients younger than 90 years of age, despite the lower prevalence of baseline comorbidities. Moreover, nonagenarians had a higher risk of in-hospital stroke, major or life-threatening bleeding, and new-onset atrial fibrillation. The STS-PROM was the only surgical risk score that accurately predicted the risk of mortality in nonagenarians.
Dr. de Brito, Jr. has served as a proctor for Edwards Lifesciences and Medtronic. Dr. Barbanti has served as a consultant for Edwards Lifesciences; has received speaker honoraria from Medtronic and Biotronik; and has served on the advisory board for Biotronik. Dr. Latib has served as a consultant for Medtronic; has received honoraria from Abbott Vascular; and has served on the advisory board for Medtronic and Abbott Vascular. Dr. Baan has received unrestricted research grant support from Edwards Lifesciences. Dr. Pan has received lecture fees from Abbott. Dr. Dumonteil has served as a consultant and has received proctoring fees from Abbott Vascular, Boston Scientific, Edwards Lifesciences, and Medtronic. Dr. Mangione has served as a proctor for Medtronic and Edwards Lifesciences. Dr. Dangas has served as a clinical trial investigator for Medtronic; has served on the advisory board for Boston Scientific; and owns equity in Claret Medical. Dr. Mehran has received institutional grant support from AstraZeneca, Bayer, Beth Israel Deaconess, Bristol-Myers Squibb, CSL Behring, Medtronic, Eli Lilly/Daiichi Sankyo, OrbusNeich, and Novartis Pharmaceuticals; is a consultant to Abbott Laboratories, PLx Opco/PLx Pharma, Siemens Medical Solutions, Regeneron Pharmaceuticals, Boston Scientific, Medscape, Roivant Sciences, Spectranetics/Philips/Volcano Corporation, and Cardiovascular Systems; has received advisory board fees to her institution from Bristol-Myers Squibb; has received executive committee fees from Janssen Pharmaceuticals and Osprey Medical; has received data and safety monitoring board membership fees to her institution from Watermark Research Partners; has <1% equity with Claret Medical and Elixir Medical; and her spouse is a consultant for Abiomed and The Medicines Company. Dr. Piek has served on the advisory board for and has received travel reimbursement from Abbott Vascular; and has served as a consultant for Philips/Volcano. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received November 26, 2018.
- Revision received February 1, 2019.
- Accepted February 19, 2019.
- 2019 American College of Cardiology Foundation
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