Author + information
- Jaya Chandrasekhar1,
- Birgit Vogel1,
- Usman Baber2,
- Susheel Kodali3,
- Paul Sorajja4,
- Wilson Y. Szeto5,
- Michael J. Reardon6,
- Jeffrey J. Popma7,
- Roxana Mehran2 and
- George Dangas8
- 1Icahn School of Medicine at Mount Sinai, New York, New York, United States
- 2Zena and Michael A. Wiener Cardiovascular Institute, Mount Sinai Hospital, New York, New York, United States
- 3New York-Presbyterian Hospital/Columbia University Medical Center, New York, New York, United States
- 4Minneapolis Heart Institute, Minneapolis, Minnesota, United States
- 5University of Pennsylvania, Philadelphia, Pennsylvania, United States
- 6Houston Methodist DeBakey Heart & Vascular Center, Houston, Texas, United States
- 7Beth Israel Deaconess Medical Center, Boston, Massachusetts, United States
- 8Mount Sinai Medical Center, New York, New York, United States
Atrial fibrillation (AF) is associated with greater morbidity in patients undergoing transcatheter aortic valve replacement (TAVR). We compared clinical outcomes in patients undergoing TAVR with commercially approved self-expanding devices by presence or absence of prior AF.
Patients in the STS/ACC TVT Registry receiving a self-expanding Medtronic (Minneapolis, MN) TAVR device for significant aortic valve stenosis between Jan 2014 and Sept 2015 were included, and stratified by the presence or absence of baseline AF. The incidence of in-hospital events was reported, and 30-day site-reported clinical events were analyzed in a time to event manner using Kaplan-Meier (KM) methods. The main endpoints of interest were death and stroke.
The study sample included 10,464 TAVR patients, of which 42.9% (n=4491) had baseline AF and 57.1% (n=5973) had no AF. Baseline AF patients were older, more commonly men, with a greater prevalence of prior stroke and cardiac surgery, and higher mean STS score compared to patients without baseline AF (Table). The mean CHA2DS2VASc score was ≥3 in 98.6% AF and 96.6% no-AF patients (p<0.001). Patients with AF versus no-AF were more frequently discharged on an anticoagulant. The incidence of in-hospital stroke and mortality, and the 30-day KM stroke rate were similar between the two groups, however 30-day mortality KM rates were higher in AF patients (Table). Adjusted hazard for adverse events by AF status will be available at time of presentation.
|AF (n=4491)||No AF (n=5973)||p-value|
|Prior cardiac surgery||35.5%||32.2%||<0.001|
|STS Score (%)||9.3±5.6||7.8±5.1||<0.001|
|Discharge oral anticoagulant||59.4%||9.4%||<0.001|
|30-day stroke (KM rate)||2.9%||2.7%||0.42|
|30-day mortality (KM rate)||5.5%||4.4%||0.02|
Baseline AF is associated with significantly greater rates of early mortality but not stroke in patients undergoing TAVR with self-expanding devices. Oral anticoagulation was underutilized in AF-TAVR patients at discharge, which may be a function of underlying bleeding risk.
STRUCTURAL: Valvular Disease: Aortic