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Comparison of Outcomes of Transcatheter Aortic Valve Implantation in Patients ≥85 Years Versus Those <85 Years.
- Source :
-
The American journal of cardiology [Am J Cardiol] 2020 Aug 15; Vol. 129, pp. 60-70. Date of Electronic Publication: 2020 May 26. - Publication Year :
- 2020
-
Abstract
- The differential outcomes across the age spectrum of transcatheter aortic valve implantation (TAVI) recipients are still debated. Aim of the study was to evaluate the clinical outcomes of oldest-old patients undergoing TAVI in the large "Registro Italiano GISE sull'impianto di Valvola Aortica Percutanea (RISPEVA)" registry. A total of 3,507 patients were stratified according to age: 1,381 were ≥85 years, 2,126 were <85 years. Primary endpoints were death at 30-days and complete follow-up (FU) (medium 368 days). Cerebrovascular events, myocardial infarction, bleedings, vascular complications at 30-days and complete FU were considered. In the unadjusted analysis, 30-days mortality in the oldest-old group was higher than in younger patients (4.2% vs 2.4%; p = 0.007); this difference kept true also at complete FU (19.6% vs 15.9%; p = 0.014). After propensity score (PS) matching, the oldest-old population showed a higher mortality solely at 30-days (4.7% vs 2.4%; p = 0.016), while the survival at complete FU was similar to that of younger patients (20.1% vs 18.0%; p = 0.286). The incidence of non-fatal outcomes resulted comparable between the 2 groups, also after propensity score matching. At the multivariate logistic regression analysis procedural major or disabling bleedings, cerebrovascular events, cardiogenic shock resulted predictors of 30-days death in the oldest-old cohort. In conclusion, patients ≥85 years can safely undergo TAVI being not more exposed to procedural complications than those <85 years; nevertheless they showed worse 30-days mortality, probably driven by reduced tolerance to complications. Passed the critical periprocedural phase, patients ≥85 years had a similar survival to those <85 years with comparable risk profile.<br /> (Copyright © 2020 Elsevier Inc. All rights reserved.)
- Subjects :
- Age Factors
Aged
Aged, 80 and over
Female
Hemorrhage epidemiology
Humans
Ischemic Attack, Transient epidemiology
Italy epidemiology
Logistic Models
Male
Multivariate Analysis
Propensity Score
Registries
Shock, Cardiogenic epidemiology
Treatment Outcome
Aortic Valve Stenosis surgery
Myocardial Infarction epidemiology
Postoperative Complications epidemiology
Postoperative Hemorrhage epidemiology
Stroke epidemiology
Transcatheter Aortic Valve Replacement
Subjects
Details
- Language :
- English
- ISSN :
- 1879-1913
- Volume :
- 129
- Database :
- MEDLINE
- Journal :
- The American journal of cardiology
- Publication Type :
- Academic Journal
- Accession number :
- 32565091
- Full Text :
- https://doi.org/10.1016/j.amjcard.2020.05.033