Comparison of Mid-Term Prognosis in Intermediate-to-Low-Risk Contemporary Population with Guidelines-Oriented Age Cutoff
Background: Current European guidelines support transcatheter aortic valve implantation (TAVI) in intermediate-to-low-risk patients ≥75 years-old, but its prognostic relevance is unknown. Methods: Intermediate-to-low-risk (The Society of Thoracic Surgeons score <8%) patients enrolled in the HORSE...
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| Format: | Article |
| Language: | English |
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MDPI AG
2024-01-01
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| Series: | Journal of Cardiovascular Development and Disease |
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| Online Access: | https://www.mdpi.com/2308-3425/11/1/33 |
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| author | Stefano Benenati Francesco Gallo Won-keun Kim Arif A. Khokhar Tobias Zeus Stefan Toggweiler Roberto Galea Federico De Marco Antonio Mangieri Damiano Regazzoli Bernhard Reimers Luis Nombela-Franco Marco Barbanti Ander Regueiro Tommaso Piva Josep Rodes-Cabau Italo Porto Antonio Colombo Francesco Giannini Alessandro Sticchi |
| author_facet | Stefano Benenati Francesco Gallo Won-keun Kim Arif A. Khokhar Tobias Zeus Stefan Toggweiler Roberto Galea Federico De Marco Antonio Mangieri Damiano Regazzoli Bernhard Reimers Luis Nombela-Franco Marco Barbanti Ander Regueiro Tommaso Piva Josep Rodes-Cabau Italo Porto Antonio Colombo Francesco Giannini Alessandro Sticchi |
| author_sort | Stefano Benenati |
| collection | DOAJ |
| description | Background: Current European guidelines support transcatheter aortic valve implantation (TAVI) in intermediate-to-low-risk patients ≥75 years-old, but its prognostic relevance is unknown. Methods: Intermediate-to-low-risk (The Society of Thoracic Surgeons score <8%) patients enrolled in the HORSE registry were included. We compared the populations aged under 75 with those over 75. The primary endpoint was all-cause mortality. Results: A total of 2685 patients were included: 280 (8.6%) < 75 and 2405 ≥ 75 years. Through a mean follow-up of 437 ± 381 days, 198 (8.2%) and 23 (8.2%) patients died in the two arms without statistically significant differences (log-rank <i>p</i> = 0.925). At Cox regression analysis, age did not predict the occurrence of all-cause death, neither as a continuous variable (HR 1.01, 95% CI 0.99–1.04, <i>p</i> = 0.294) nor dichotomizing according to the prespecified cutoff of 75 years (HR 0.97, 95% CI 0.63–1.51, <i>p</i> = 0.924). Time-to-event ROC curves showed low accuracy of age to predict all-cause mortality (area under the curve of 0.54 for both 1-year and 2-year outcomes). Conclusions: TAVI has comparable benefits across age strata for intermediate-to-low-risk patients. The age cutoff suggested by the current guidelines is not predictive of the risk of adverse events during hospital stays or of all-cause mortality through a mid-term follow-up. |
| first_indexed | 2024-03-08T10:46:29Z |
| format | Article |
| id | doaj.art-abdaf001cdc7407a99fbe7f339debdae |
| institution | Directory Open Access Journal |
| issn | 2308-3425 |
| language | English |
| last_indexed | 2024-03-08T10:46:29Z |
| publishDate | 2024-01-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Journal of Cardiovascular Development and Disease |
| spelling | doaj.art-abdaf001cdc7407a99fbe7f339debdae2024-01-26T17:05:23ZengMDPI AGJournal of Cardiovascular Development and Disease2308-34252024-01-011113310.3390/jcdd11010033Comparison of Mid-Term Prognosis in Intermediate-to-Low-Risk Contemporary Population with Guidelines-Oriented Age CutoffStefano Benenati0Francesco Gallo1Won-keun Kim2Arif A. Khokhar3Tobias Zeus4Stefan Toggweiler5Roberto Galea6Federico De Marco7Antonio Mangieri8Damiano Regazzoli9Bernhard Reimers10Luis Nombela-Franco11Marco Barbanti12Ander Regueiro13Tommaso Piva14Josep Rodes-Cabau15Italo Porto16Antonio Colombo17Francesco Giannini18Alessandro Sticchi19Dipartimento di Medicina Interna e Specialità Mediche (DIMI), University of Genoa, 16126 Genoa, ItalyInterventional Cardiology, Department of Cardio-Thoracic and Vascular Sciences, Ospedale dell’Angelo, AULSS3 Serenissima, Mestre, 30174 Venezia, ItalyDepartment of Cardiology, Kerckhoff Heart Center, 61231 Bad Nauheim, GermanyCardiology Service, Imperial College Healthcare NHS Trust, London W12 0HS, UKDivision of Cardiology, Pulmonology and Vascular Medicine, Heinrich Heine University, 40225 Duesseldorf, GermanyDepartment of Cardiology, Cantonal Hospital Lucern, 6000 Luzern, SwitzerlandDepartment of Cardiology, Inselspital, Bern University Hospital, University of Bern, 3010 Bern, SwitzerlandCentro Cardiologico Monzino IRCCS, 20100 Milan, ItalyCardio Center, IRCCS Humanitas Research Hospital, Rozzano, 20089 Milan, ItalyCardio Center, IRCCS Humanitas Research Hospital, Rozzano, 20089 Milan, ItalyCardio Center, IRCCS Humanitas Research Hospital, Rozzano, 20089 Milan, ItalyInterventional Cardiology Unit, Hospital Àlvaro Cunqueiro, 36312 Vigo, SpainFaculty of Medicine and Surgery, Università degli Studi di Enna “Kore”, 94100 Enna, ItalyCardiovascular Institute, Hospital Clinic, Institut D’investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), 08036 Barcelona, SpainInterventional Cardiology, Ospedali Riuniti Di Ancona, 60126 Ancona, ItalyQuebec Heart and Lung Institute, Laval University, Quebec City, QC G1V 4G5, CanadaDipartimento di Medicina Interna e Specialità Mediche (DIMI), University of Genoa, 16126 Genoa, ItalyCardio Center, IRCCS Humanitas Research Hospital, Rozzano, 20089 Milan, ItalyInterventional Cardiology Unit, IRCCS Ospedale Galeazzi Sant’Ambrogio, 20157 Milan, ItalyCardio Center, IRCCS Humanitas Research Hospital, Rozzano, 20089 Milan, ItalyBackground: Current European guidelines support transcatheter aortic valve implantation (TAVI) in intermediate-to-low-risk patients ≥75 years-old, but its prognostic relevance is unknown. Methods: Intermediate-to-low-risk (The Society of Thoracic Surgeons score <8%) patients enrolled in the HORSE registry were included. We compared the populations aged under 75 with those over 75. The primary endpoint was all-cause mortality. Results: A total of 2685 patients were included: 280 (8.6%) < 75 and 2405 ≥ 75 years. Through a mean follow-up of 437 ± 381 days, 198 (8.2%) and 23 (8.2%) patients died in the two arms without statistically significant differences (log-rank <i>p</i> = 0.925). At Cox regression analysis, age did not predict the occurrence of all-cause death, neither as a continuous variable (HR 1.01, 95% CI 0.99–1.04, <i>p</i> = 0.294) nor dichotomizing according to the prespecified cutoff of 75 years (HR 0.97, 95% CI 0.63–1.51, <i>p</i> = 0.924). Time-to-event ROC curves showed low accuracy of age to predict all-cause mortality (area under the curve of 0.54 for both 1-year and 2-year outcomes). Conclusions: TAVI has comparable benefits across age strata for intermediate-to-low-risk patients. The age cutoff suggested by the current guidelines is not predictive of the risk of adverse events during hospital stays or of all-cause mortality through a mid-term follow-up.https://www.mdpi.com/2308-3425/11/1/33aortic stenosistranscatheter aortic valve replacementagesurgical risklow–intermediate risk |
| spellingShingle | Stefano Benenati Francesco Gallo Won-keun Kim Arif A. Khokhar Tobias Zeus Stefan Toggweiler Roberto Galea Federico De Marco Antonio Mangieri Damiano Regazzoli Bernhard Reimers Luis Nombela-Franco Marco Barbanti Ander Regueiro Tommaso Piva Josep Rodes-Cabau Italo Porto Antonio Colombo Francesco Giannini Alessandro Sticchi Comparison of Mid-Term Prognosis in Intermediate-to-Low-Risk Contemporary Population with Guidelines-Oriented Age Cutoff Journal of Cardiovascular Development and Disease aortic stenosis transcatheter aortic valve replacement age surgical risk low–intermediate risk |
| title | Comparison of Mid-Term Prognosis in Intermediate-to-Low-Risk Contemporary Population with Guidelines-Oriented Age Cutoff |
| title_full | Comparison of Mid-Term Prognosis in Intermediate-to-Low-Risk Contemporary Population with Guidelines-Oriented Age Cutoff |
| title_fullStr | Comparison of Mid-Term Prognosis in Intermediate-to-Low-Risk Contemporary Population with Guidelines-Oriented Age Cutoff |
| title_full_unstemmed | Comparison of Mid-Term Prognosis in Intermediate-to-Low-Risk Contemporary Population with Guidelines-Oriented Age Cutoff |
| title_short | Comparison of Mid-Term Prognosis in Intermediate-to-Low-Risk Contemporary Population with Guidelines-Oriented Age Cutoff |
| title_sort | comparison of mid term prognosis in intermediate to low risk contemporary population with guidelines oriented age cutoff |
| topic | aortic stenosis transcatheter aortic valve replacement age surgical risk low–intermediate risk |
| url | https://www.mdpi.com/2308-3425/11/1/33 |
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