TCT-48 Incidence and Outcomes of Atrial Fibrillation in Patients Undergoing TAVR Versus SAVR: Experience From SURTAVI and Low-Risk Randomized Studies
Background
Atrial fibrillation (AF) is common among patients with aortic valve replacement (AVR) and has been associated with worse outcomes. We evaluated incidence, predictors, management, and outcomes in patients undergoing surgical (S)AVR and transcatheter (T)AVR at low-to-intermediate risk.
Methods
Data from the randomized intermediate-risk CoreValve SURTAVI and Evolut (Medtronic) Low-Risk trials were pooled. Patients were stratified by baseline AF, new AF within 14 days, or no new AF ≤ 14 days. Multivariable regression was used to identify predictors of new AF. Clinical outcomes are reported as landmarked Kaplan-Meier estimates from 15 days to 2 years.
| TAVR | SAVR | |||||||
|---|---|---|---|---|---|---|---|---|
| No. of patients (Kaplan-Meier estimates) | Base-line AF (N=359) | New AF within 14 days (N=104) | No AF burden (N=1128) | Log-rank P value | Baseline AF (N=318)) | New AF within 14 days (N=499) | No AF burden (N=66) | Log-rank P value |
| Death or disabling stroke | 40 (11.6) | 7 (6.9) | 67 (6.2) | 0.003 | 41 (13.8) | 28 (6.2) | 24 (4.0) | < 0.01 |
| Death | 39 (11.2) | 5 (4.9) | 63 (5.8) | 0.001 | 39 (13.0) | 29 (6.2) | 21 (3.4) | < 0.001 |
| Disabling stroke | 7 (2.1) | 3 (3.0) | 8 (0.8) | 0.030 | 8 (2.8) | 7 (1.5) | 4 (0.7) | 0.037 |
| All stroke/TIA | 26 (8.0%) | 8 (8.5%) | 45 (4.3%) | 0.015 | 16 (5.9%) | 26 (6.0%) | 19 (3.3%) | 0.073 |
| Life-threatening or disabling bleeding | 17 (5.2) | 4 (4.5) | 18 (1.7) | 0.002 | 14 (5.2) | 13 (3.0) | 10 (1.7) | 0.017 |
Results
Of 3,069 patients (1,591 TAVR, 1,478 SAVR), 22.6% of TAVR and 21.5% of SAVR patients had baseline AF; 6.5% of TAVR and 33.8% of SAVR patients had new AF. Patients with new AF after TAVR were more likely to be women, have peripheral artery disease (PAD), and chronic lung disease. At discharge, 70% of TAVR and 67% of SAVR patients with new AF were on anticoagulation therapy. Significant predictors of new AF in TAVR patients were chronic lung disease (hazard ratio [HR]: 1.69; 95% confidence interval [CI]: 1.12-2.57), PAD (HR: 2.11; 95% CI: 1.38-3.23), and baseline mean gradient (HR: 1.02/mm Hg; 95% CI: 1.00-1.03). Only age predicted new AF among SAVR patients (HR: 1.03 per year; 95% CI: 1.01-1.04). Among TAVR patients, the rate of death and disabling stroke at 2 years was similar between patients with new AF and no AF and lower than baseline AF patients; the risk of all stroke and transient ischemic attack (TIA) and stroke and disabling bleeding was significantly higher among patients with new AF compared with those with no AF and similar to those with baseline AF. Among SAVR patients, there was a higher risk of death or disabling stroke, all stroke and TIA, and disabling bleeding with new AF compared with no AF (Table 1).
Conclusion
In the SURTAVI and Low-Risk trials, new AF was more common following SAVR compared with TAVR, with only 70% of patients discharged on anticoagulation. New AF is associated with higher death or disabling stroke after SAVR but higher bleeding and stroke and TIA after TAVR.
Categories
STRUCTURAL: Valvular Disease: Aortic
