Prognostic Impact of Guidelines-oriented Age Cut-off in Intermediate-to-low Risk Patients Undergoing Transcatheter Aortic Valve Implantation in a Large Real-world Multicenter Registry

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

doi:10.20944/preprints202305.2019.v1

Preprint Article Version 1 Preserved in Portico This version is not peer-reviewed

Version 1 : Received: 28 May 2023 / Approved: 29 May 2023 / Online: 29 May 2023 (14:36:38 CEST)

Background: Current European guidelines support transcatheter aortic valve implantation (TA-VI) in intermediate to low-risk patients ≥75 years-old but its prognostic relevance is unknown. Methods: Intermediate-to-low-risk (Society of Thoracic Surgeon score <8%) patients enrolled in the HORSE registry were included. We compared the population with less versus more than 75 years old. 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 p=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, p=0.294) nor dichotomizing according to the prespecified cutoff of 75 years (HR 0.97, 95% CI 0.63-1.51p=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 in intermediate-to-low risk patients. The age cut-off suggested by current guidelines is not predictive of the risk of adverse events during hospital stay, neither of all-cause mortality through a mid-term follow-up.

aortic stenosis; transcatheter aortic valve replacement; age; surgical risk; low-intermediate risk

Medicine and Pharmacology, Cardiac and Cardiovascular Systems

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Prognostic Impact of Guidelines-oriented Age Cut-off in Intermediate-to-low Risk Patients Undergoing Transcatheter Aortic Valve Implantation in a Large Real-world Multicenter Registry

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