Masahiko Noguchi1, Minoru Tabata2, Kotaro Obunai1, Kentaro Shibayama1, Joji Ito2, Hiroyuki Watanabe1, Fumiaki Yashima3, Yusuke Watanabe4, Toru Naganuma5, Motoharu Araki6, Futoshi Yamanaka7, Shinichi Shirai8, Hiroshi Ueno9, Kazuki Mizutani10, Akihiro Higashimori11, Kensuke Takagi12, Norio Tada13, Masanori Yamamoto14,15, Kentaro Hayashida16. 1. Department of Cardiology, Tokyo Bay Urayasu Ichikawa Medical Center, Urayasu, Japan. 2. Department of Cardiovascular Surgery, Tokyo Bay Urayasu Ichikawa Medical Center, Urayasu, Japan. 3. Department of Cardiology, Saiseikai Utsunomiya Hospital, Utsunomiya, Japan. 4. Department of Cardiology, Teikyo University School of Medicine, Tokyo, Japan. 5. Department of Cardiology, New Tokyo Hospital, Matsudo, Japan. 6. Department of Cardiology, Saiseikai Yokohama City Eastern Hospital, Yokohama, Japan. 7. Department of Cardiology, Shonan Kamakura General Hospital, Kamakura, Japan. 8. Department of Cardiology, Kokura Memorial Hospital, Kitakyushu, Japan. 9. Department of Cardiovascular Medicine, Toyama University Hospital, Toyama, Japan. 10. Department of Cardiovascular Medicine, Osaka City University Graduate School of Medicine, Osaka, Japan. 11. Department of Cardiology, Kishiwada Tokushukai Hospital, Kishiwada, Japan. 12. Department of Cardiology, Ogaki Municipal Hospital, Ogaki, Japan. 13. Department of Cardiology, Sendai Kosei Hospital, Sendai, Japan. 14. Department of Cardiology, Toyohashi Heart Center, Toyohashi, Japan. 15. Department of Cardiology, Nagoya Heart Center, Nagoya, Japan. 16. Department of Cardiology, Keio University School of Medicine, Tokyo, Japan.
Abstract
OBJECTIVES: The purpose of this study was to investigate 30-day and 2-year clinical outcomes, and predictors of 2-year mortality in nonagenarians undergoing transcatheter aortic valve implantation (TAVI). BACKGROUND: TAVI has been applied to nonagenarians. However, sufficient clinical data in nonagenarians who could benefit from TAVI are limited. METHODS: We evaluated the data from the optimized catheter valvular intervention-TAVI registry. Clinical outcomes were compared between patients' age ≥90 years and age <90 years. Predictive factors of 2-year mortality were assessed by multivariable Cox regression analyses. RESULTS: From October 2013 to May 2017, a total of 375 nonagenarians (age ≥90 years) and 2,213 younger patients (age <90 years) were included. Although nonagenarians had a higher surgical risk score, 30-day clinical outcomes were similar between two groups. There were no significant differences in 2-year mortality (22.0% vs. 17.3%; p = .11) and stroke (5.5% vs. 3.9%; p = .31); however, 2-year heart failure readmission was higher in nonagenarians (13.3% vs. 9.0%; p = .03). After adjusting covariates, age ≥90 years was not independent predictor for 2-year outcomes. In nonagenarians, female sex (hazard ratio [HR] = 0.43; 95% confidence interval [CI] = 0.26-0.74; p = .002), chronic kidney disease grade ≥4 (HR = 2.14; 95% CI = 1.21-3.64; p = .01), and Clinical Frailty Scale ≥4 (HR = 1.82; 95% CI = 1.02-3.42; p = .04) were independently associated with 2-year mortality. CONCLUSIONS: Clinical outcomes of TAVI in selected nonagenarians were favorable. Severe renal dysfunction and frailty may be important factors to predict mid-term mortality after TAVI in nonagenarians.
OBJECTIVES: The purpose of this study was to investigate 30-day and 2-year clinical outcomes, and predictors of 2-year mortality in nonagenarians undergoing transcatheter aortic valve implantation (TAVI). BACKGROUND: TAVI has been applied to nonagenarians. However, sufficient clinical data in nonagenarians who could benefit from TAVI are limited. METHODS: We evaluated the data from the optimized catheter valvular intervention-TAVI registry. Clinical outcomes were compared between patients' age ≥90 years and age <90 years. Predictive factors of 2-year mortality were assessed by multivariable Cox regression analyses. RESULTS: From October 2013 to May 2017, a total of 375 nonagenarians (age ≥90 years) and 2,213 younger patients (age <90 years) were included. Although nonagenarians had a higher surgical risk score, 30-day clinical outcomes were similar between two groups. There were no significant differences in 2-year mortality (22.0% vs. 17.3%; p = .11) and stroke (5.5% vs. 3.9%; p = .31); however, 2-year heart failure readmission was higher in nonagenarians (13.3% vs. 9.0%; p = .03). After adjusting covariates, age ≥90 years was not independent predictor for 2-year outcomes. In nonagenarians, female sex (hazard ratio [HR] = 0.43; 95% confidence interval [CI] = 0.26-0.74; p = .002), chronic kidney disease grade ≥4 (HR = 2.14; 95% CI = 1.21-3.64; p = .01), and Clinical Frailty Scale ≥4 (HR = 1.82; 95% CI = 1.02-3.42; p = .04) were independently associated with 2-year mortality. CONCLUSIONS: Clinical outcomes of TAVI in selected nonagenarians were favorable. Severe renal dysfunction and frailty may be important factors to predict mid-term mortality after TAVI in nonagenarians.
Authors: Konrad Nilsson; Sergio Buccheri; Christina Christersson; Sasha Koul; Johan Nilsson; Pétur Pétursson; Henrik Renlund; Andreas Rück; Stefan James Journal: Eur Heart J Qual Care Clin Outcomes Date: 2022-03-02