Amyloidosis is a systemic disease that affects different organs and impairs their function.
Recent studies with magnetic resonance imaging (MRI) have shown that between 13% and 16% of patients who undergo transcatheter aortic valve replacement (TAVR) have amyloidosis.
A review of four studies showed that mortality at 20 months was twice as high when amyloidosis was present after device implantation. However, other more recent studies show no difference in mortality.
Researchers analyzed the US NRD (Nationwide Readmissions Database) from January 2016 to December 2019 and included 244,967 hospitalizations for TAVR. Among these cases, 273 patients had amyloidosis (0.11%).
Mean age was 79 years and most subjects were female. There was a greater presence of atrial fibrillation and impaired renal function. However, these patients also exhibited lower levels of hypertension, diabetes, and MRS.
There were no differences in in-hospital mortality or 30-day readmissions (1.8% vs. 1.5%, p = 0.622; and 12.9% vs. 12.5%, p = 0.858; respectively). The rate of acute ischemic stroke was higher in patients with amyloidosis (6.2% vs. 1.8%, p < 0.001), and so was the rate of acute ischemic and hemorrhagic stroke (7.2% vs. 1.8%, p < 0.001).
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A propensity score was estimated by logistic regression and results showed that the group with amyloidosis was associated with a higher risk of acute ischemic stroke (odds ratio [OR] 3.08; 95% confidence interval [CI]: 1.41-6.71; p = 0.005), but there were no differences in mortality (OR: 0.79; 95% CI: 0.28-2.27, p = 0.666) and 30-day readmissions (hazard ratio: 0.72; 95% CI: 0.41-1.25; p = 0.241) in TAVI.
Conclusion
This analysis suggests that amyloidosis may be associated with a higher risk of thromboembolism after TAVR. However, these data warrant further investigation.
Dr. Carlos Fava.
Member of the Editorial Board of SOLACI.org.
Original Title: Outcomes of Transcatheter Aortic Valve Replacement in Patients With Coexisiting Amyloidosis. Mortality, Stroke, and Readmission.
Reference: Mohammed Elzeneini, et al JACC Adv 2023;-:100255 Article in press.
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