American heart journal plus : cardiology research and practice · 2026
Clinical outcomes following transcatheter aortic valve replacement in patients with concordant versus discordant aortic stenosis.
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Hundal Prabhjot, Abood Zaid, Zlochiver Viviana, Boulware David, Osman Mohamed, Jain Renuka, Allaqaband Suhail, Bajwa Tanvir, Tajik A Jamil, Jan M Fuad
Аннотация
STUDY OBJECTIVE: This study aimed to evaluate clinical outcomes of patients with symptomatic discordant (aortic stenosis) AS following transcatheter aortic valve replacement (TAVR).
DESIGN: This is a retrospective cohort study.
SETTING: Patients who underwent a TAVR for severe symptomatic native AS with preserved left ventricular ejection fraction ≥50% from 2012 to 2022 at our institution were included.
PARTICIPANTS: Patients were divided into two cohorts, concordant AS (met all AS criteria) and discordant AS (< 3 criteria).
INTERVENTIONS: TAVR.
MAIN OUTCOMES MEASURES: The primary endpoint was all cause mortality and secondary outcomes were hospital readmissions for myocardial infarction (MI) and stroke.
RESULTS: This study evaluated 2021 patients; the median age was 82.6 (77.0-87.2) years, and 53% were female. There was no difference in long-term mortality between discordant or concordant AS (HR: 0.89 [95% CI: 0.77-1.02]; P = 0.09). However, the discordant group had a higher 1-year mortality rate than the concordant group (14.5% vs 10.1%, respectively; P = 0.0054) and comparable mortality rates at 5 years (52.0% vs 50.5%, respectively; P = 0.18). The long-term readmission rate for MI was higher for the discordant group (HR: 0.47 [95% CI: 0.27-0.80]; P = 0.005), and there was no difference in readmission for stroke or transient ischemic attack (HR: 1.33 [95% CI: 0.92-1.94]; P = 0.133).
CONCLUSIONS: Patients with symptomatic severe AS with discordant echocardiographic findings may have similar survival outcomes than those with concordant AS after undergoing TAVR.
DESIGN: This is a retrospective cohort study.
SETTING: Patients who underwent a TAVR for severe symptomatic native AS with preserved left ventricular ejection fraction ≥50% from 2012 to 2022 at our institution were included.
PARTICIPANTS: Patients were divided into two cohorts, concordant AS (met all AS criteria) and discordant AS (< 3 criteria).
INTERVENTIONS: TAVR.
MAIN OUTCOMES MEASURES: The primary endpoint was all cause mortality and secondary outcomes were hospital readmissions for myocardial infarction (MI) and stroke.
RESULTS: This study evaluated 2021 patients; the median age was 82.6 (77.0-87.2) years, and 53% were female. There was no difference in long-term mortality between discordant or concordant AS (HR: 0.89 [95% CI: 0.77-1.02]; P = 0.09). However, the discordant group had a higher 1-year mortality rate than the concordant group (14.5% vs 10.1%, respectively; P = 0.0054) and comparable mortality rates at 5 years (52.0% vs 50.5%, respectively; P = 0.18). The long-term readmission rate for MI was higher for the discordant group (HR: 0.47 [95% CI: 0.27-0.80]; P = 0.005), and there was no difference in readmission for stroke or transient ischemic attack (HR: 1.33 [95% CI: 0.92-1.94]; P = 0.133).
CONCLUSIONS: Patients with symptomatic severe AS with discordant echocardiographic findings may have similar survival outcomes than those with concordant AS after undergoing TAVR.