June 5, 2020
Study Reports on Trends and Outcomes of TAVR in Patients With Cardiogenic Shock
June 5, 2020—In Journal of the American College of Cardiology (JACC): Cardiovascular Interventions, Luke Masha, MD, et al published findings on the trends and outcomes in patients in the United States undergoing transcatheter aortic valve replacement (TAVR) who present preprocedurally with cardiogenic shock (2020;13:1314-1325).
As summarized in JACC: Cardiovascular Interventions, the investigators concluded that TAVR appears to be a viable treatment option for patients presenting with aortic stenosis and acute cardiogenic shock. They found that although procedural success is high, this population remains at an elevated risk of death, which appears to be mostly driven by the degree of preprocedural shock.
The investigators used the Society of Thoracic Surgeons (STS) and the American College of Cardiology Transcatheter Valve Therapy registry linked with Centers for Medicare & Medicaid Services claims data to identify patients between 2014 and 2017 who presented with cardiogenic shock before TAVR in comparison to a high-risk cohort that did not present with cardiogenic shock. The primary outcome of interest was 30-day mortality. Secondary outcomes included 30-day procedural complications.
Presentations with cardiogenic shock currently represent 4.1% of the TAVR population in the United States. In the study, a total of 2,220 patients with acute cardiogenic shock undergoing TAVR (median STS score, 9.8) were compared with 12,851 high-risk patients (median STS score, 10.2).
The investigators reported the following in JACC: Cardiovascular Interventions:
- Cardiogenic shock was associated with higher 30-day mortality (19.1% vs 4.9%) and higher rates of complications.
- The absence of 30-day major complications was not associated with a marked reduction in 30-day mortality.
- Overall procedural success rates were high.
- The risk of death from acute cardiogenic shock before TAVR was strongly related to the degree of shock preprocedure.