Inter-racial differences in patients undergoing transcatheter aortic valve implantation

Abstract

ObjectiveLittle information exists about inter-racial differences in patients with aortic stenosis (AS) undergoing transcatheter aortic valve implantation (TAVI). We investigated whether differences in baseline characteristics between Asian and non-Asian population may contribute to disparities in clinical outcomes after TAVI.MethodsWe performed a registry-based, multinational cohort study of patients with severe AS who underwent TAVI at two centres in the USA and one centre in South Korea. The primary outcome was a composite of death, stroke or rehospitalisation at 1 year.ResultsOf 1412 patients, 581 patients were Asian and 831 were non-Asian (87.5% white, 1.7% black, 6.1% Hispanic or 4.7% others). There were substantial differences in baseline characteristics between two racial groups. The primary composite outcome was significantly lower in the Asian group than in the non-Asian group (26.0% vs 35.0%; HR 0.73; 95% CI 0.59 to 0.89; p=0.003). However, after adjustment of baseline covariates, the risk of primary composite outcome was not significantly different (HR 0.79; 95% CI 0.60 to 1.03; p=0.08). The all-cause mortality at 1 year was significantly lower in the Asian group than the non-Asian group (7.4% vs 12.5%; HR 0.60; 95% CI 0.41 to 0.88; p=0.009). After multivariable adjustment, the risk of all-cause mortality was also similar (HR 1.17; 95% CI 0.73 to 1.88; p=0.52).ConclusionsThere were significant differences in baseline and procedural factors among Asian and non-Asian patients who underwent TAVI. Observed inter-racial differences in clinical outcomes were largely explained by baseline differences in clinical, anatomical and procedural factors.Trial registration numberNCT03826264 (https://wwwclinicaltrialsgov).

Race-Specific Impact of Conventional Surgical Risk Score on 1-Year Mortality After Transcatheter Aortic Valve Replacement

“…All components of the primary and secondary clinical outcomes were adjudicated by an independent group of clinicians blinded to the participating centers, race, and device type. 20 , 21 …”

“…The TP-TAVR registry contains data from a multinational, multicenter, observational cohort study that included all consecutive patients with symptomatic severe AS who underwent TAVR at 2 major academic medical centers in the United States (Stanford University School of Medicine, Stanford, California, and the Feinberg School of Medicine at Northwestern University, Chicago, Illinois) and 1 in South Korea (Asan Medical Center, Seoul) ( NCT03826264 ). 20 , 21 Beginning in February 2019, data were retrospectively collected for cases performed before initiation and prospectively thereafter. Each center’s institutional review board or ethics committee approved the registry protocol.…”

“…Procedural planning, including the type (eg, balloon-expandable or self-expandable devices) and size of the TAVR valve, access site, and pre-implantation balloon aortic valvuloplasty, were determined based on the review of multimodality imaging by the local multidisciplinary heart team. 20 , 21 After the TAVR procedure, the patients were prescribed single or dual antiplatelet therapy or oral anticoagulants (eg, warfarin or direct oral anticoagulants) if clinically indicated.…”

Sex-Specific Disparities in Clinical Outcomes After Transcatheter Aortic Valve Replacement Among Different Racial Populations

“…The TP-TAVR registry ( NCT03826264 ) is a multinational, multicenter, observational cohort study including consecutive patients with symptomatic severe AS who underwent TAVR at 2 major centers in the United States (Stanford University School of Medicine, Stanford, California, and Northwestern University Feinberg School of Medicine, Chicago, Illinois) and 1 major center in South Korea (Asan Medical Center, Seoul). 25 , 26 Beginning in February 2019, data were retrospectively collected for cases performed before initiation and prospectively thereafter. All 3 databases were standardized according to the common database model and combined according to the data use agreement among participating centers.…”

“…Procedural planning, including type and size of TAVR valve, access site, and use of pre- or post-balloon aortic valvuloplasty, were determined based on a review of multimodality imaging. 25 , 26 Following TAVR, patients were prescribed single or dual antiplatelet therapy with aspirin and clopidogrel (for at least 6 months) or oral anticoagulants (eg, warfarin or direct oral anticoagulant agents), if clinically indicated.…”