Mortality in patients with chronic obstructive pulmonary disorder undergoing transcatheter aortic valve replacement: The importance of chronic obstructive pulmonary disease exacerbation

Temporal Trends in 1-Year Cause-Specific Mortality After TAVR: Insights From the STS/ACC TVT Registry

BACKGROUND

The impact of changing patient demographics and risk profiles on cause-specific mortality after transcatheter aortic valve replacement (TAVR) remains unclear.

OBJECTIVES

The aim of this study was to examine causes of death (CoDs) and temporal trends and predictors of cause-specific mortality after TAVR.

METHODS

Data from the Society of Thoracic Surgeons/American College of Cardiology TVT (Transcatheter Valve Therapy) Registry were analyzed to identify patients who underwent isolated TAVR between January 2012 and October 2022 who had available information on 1-year CoD. The primary outcome was cause-specific (cardiac and noncardiac) mortality at 1 year. Fine and Gray subdistribution hazard models were used to account for the competing risk for cause-specific death.

RESULTS

Of 36,877 patients who died within 1 year after TAVR and had available information on CoD, 11,560 (31.3%) had cardiac death and 25,317 (68.7%) had noncardiac death. There was an initial decline in the risk-adjusted hazards of 1-year cardiac and noncardiac death after TAVR from 2012 to 2017 (adjusted HR per year: 0.95 [95% CI: 0.92-0.97] and 0.92 [95% CI: 0.90-0.93], respectively), followed by an increase from 2018 to 2022 (adjusted HR per year: 1.07 [95% CI: 1.05-1.09] and 1.22 [95% CI: 1.20-1.24], respectively). Age >80 years, comorbidities, poor functional status, nonelective procedure, nonfemoral access, and in-hospital complications were identified as independent predictors of both cardiac and noncardiac death after TAVR.

CONCLUSIONS

Noncardiac causes account for two-thirds of deaths within 1 year after TAVR. Further studies are needed to examine whether the COVID-19 pandemic, the rapid expansion in the number of TAVR sites, or other patient and hospital characteristics contributed to the increased risk for cardiac and noncardiac death after TAVR in recent years.

Treatment intensity level as a proxy for severity of chronic obstructive pulmonary disease: A risk stratification tool

BACKGROUND

Increasing severity of chronic obstructive pulmonary disease (COPD) is associated with increasing risk of poor outcomes. Using health registry data, we aimed to assess the association between treatment intensity levels (TIL), as a proxy for underlying COPD severity, and long-term outcomes.

METHODS

Using Danish nationwide registries, we identified patients diagnosed with COPD during 2001-2016, who were alive at index date of 1 January 2017. We stratified patients into exclusive TILs from least to most severe: no use, short term therapy, mono-, dual-, triple therapy, oral corticosteroid (OCS), and long-term oxygen treatment (LTOT). Survival analyses were used to assess 5-year outcomes by TIL.

RESULTS

We identified 53,803 patients with COPD in the study period (median age: 72 years [inter quartile range, 64-80], 48 % male). The three most severe TILs were associated with a significant incremental increase in all-cause mortality with an adjusted hazard ratio (aHR) for triple therapy, OCS and LTOT of 1.44 (95 % CI: 1.38-1.51), 1.67 (95 % CI: 1.59-1.75), and 2.91 (95 % CI: 2.76-3.07) compared with those receiving no therapy as reference. The same pattern was evident for the composite outcome of 5-year mortality or COPD-related hospitalization with an aHR for triple therapy, OCS and LTOT of 2.30 (95 % CI: 2.22-2.38), 2.85 (95 % CI: 2.74-2.96), and 4.00 (95 % CI: 3.81-4.20), respectively.

CONCLUSION

Increasing TILs were associated with increasing five-year mortality and risk of COPD-related hospitalization. TILs may be used as a proxy for underlying COPD severity in epidemiological studies.

Clinical implication of the Naples prognostic score on transcatheter aortic valve replacement in patients with severe aortic stenosis

BACKGROUND

One of the hallmarks of frailty in patients with severe aortic stenosis (AS) is malnutrition, for which one of the most up-to-date scoring systems is the Naples prognostic score (NPS). This study sought to investigate the predictive role of the NPS in determining mortality in patients undergoing transcatheter aortic valve replacement (TAVR) under long-term follow-up.

METHODS

A total of 430 consecutive patients with symptomatic severe AS who underwent TAVR were included retrospectively. The primary endpoint of the study was the long-term all-cause mortality. The study population was divided into two groups according to the NPS value, including Group 1 (NPS 0-2) and Group 2 (NPS 3-4).

RESULTS

The all-cause mortality occurred in 250 patients (62.5%) patients during a follow-up time of 40.6 (22.0-69.4) months. During the follow-up period, all-cause mortality was higher in Group 2 compared with Group 1 (87.9% vs. 42.9%, p < 0.001). Older age (p < 0.001), chronic obstructive pulmonary disease (p = 0.015), left ventricular ejection fraction (p = 0.021), and being in Group 2 (high NPS) (hazard ratio: 7.058, 95% confidence interval: 5.174-9.629, p < 0.001) were found to be independent predictors of all-cause mortality at long-term follow-up.

CONCLUSION

The NPS as a malnutrition and inflammation marker in patients with severe aortic stenosis who underwent TAVR provides valuable information for all-cause mortality under long-term follow-up.