Impact of Age on Procedural Timing for Asymptomatic Severe Aortic Stenosis: Results from the Early TAVR Trial
Philippe Genereux MD, M.D., Atlantic Health System, Morristown, NJ
Philippe Genereux MD, M.D.1, Allan Schwartz, M.D.2, David J. Cohen, M.D., FSCAI3, Brian Lindman, MD, MSCI4, Philippe Pibarot, DVM, Ph.D5, Yizhuo Wang, PhD6 and Martin B. Leon, M.D.2, (1)Atlantic Health System, Morristown, NJ, (2)NewYork-Presbyterian Columbia University Irving Medical Center, New York, NY, (3)St. Francis Hospital, New York, NY, (4)Vanderbilt University, Nashville, TN, (5)Laval University, Quebec Heart-Lung Institute, Québec, FL, (6)Edwards Lifesciences, Irvine, CA
Keywords: TAVI/TAVR/Aortic Valve
Background
For patients with asymptomatic, severe aortic stenosis (AS), the EARLY TAVR trial demonstrated that a strategy of early transcatheter aortic valve replacement (TAVR) was superior to clinical surveillance (CS) for the primary endpoint of death, stroke, or unplanned cardiovascular hospitalization. Prior studies have shown that advanced age is associated with worse outcomes after AVR. Whether patient age affects outcomes based on a strategy of early TAVR versus CS is unknown.
Methods
At 75 centers in the United States and Canada, 901 patients with asymptomatic severe AS were randomized to early TAVR (n=455) or CS (n=446). Median (IQR) follow-up time was 3.8 (2.8-5.0) years. The association between age and the primary and secondary clinical endpoints were examined in each group. We also evaluated whether there was an interaction between age and treatment group assignment with respect to the primary and secondary endpoints. Associations between age, treatment group, and both cardiac remodeling and quality of life will also be examined.
Results
The mean age was 76 ± 6.0 years. Among all patients in the trial, 141 (15.6%) were 65–69 yrs, 263 (29.2%) were 70-74 yrs, 250 (27.7%) were 75-79 yrs, 175 (19.4%) were 80-84 yrs and 72 (8.0%) were ≥ 85 yrs of age. Baseline characteristics and health status were similar between treatment groups. The associations between age and clinical outcomes as well as the interactions between age and treatment group with respect to clinical outcomes will be available by the time of presentation.
Conclusions
This presentation will provide the first report from the randomized, controlled EARLY TAVR trial on whether a patient’s age should influence decision-making on procedural timing for patients with asymptomatic, severe AS.