SPC365

Characterisation of pre-intervention outcomes in very old patients with severe aortic stenosis

Session: SESSÃO DE POSTERS 04 - AMILOIDOSE E AORTA
Speaker: ADRIANA VAZÃO

Congress: CPC 2025
Topic: K. Cardiovascular Disease In Special Populations
Theme: 30. Cardiovascular Disease in Special Populations
Subtheme: 30.5 Cardiovascular Disease in the Elderly
Session Type: Cartazes
FP Number: ---
Authors: Adriana Vazão; Mónica Amado; Carolina Gonçalves; André Martins; Joana Pereira; Mariana Carvalho; Margarida Cabral; João Carvalho; Luís Graça Santos; Hélia Martins

<p style="text-align:justify"><span style="font-size:14px"><span style="font-family:Arial,Helvetica,sans-serif"><span style="color:#000000"><strong><span style="color:black">Introduction:</span></strong><strong>&nbsp;</strong><span style="color:black">Severe aortic stenosis (SAS) prevalence is increasing due to population aging and transcatheter aortic valve implantation (TAVI) is the preferred treatment option in older patients (pts).&nbsp;</span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:14px"><span style="font-family:Arial,Helvetica,sans-serif"><span style="color:#000000"><strong><span style="color:black">Objective:</span></strong><strong>&nbsp;</strong><span style="color:black">To characterize pre-intervention&nbsp;outcomes in very old pts (aged &gt;85 years) with SAS awaiting TAVI. &nbsp;</span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:14px"><span style="font-family:Arial,Helvetica,sans-serif"><span style="color:#000000"><strong><span style="color:black">Methods:</span></strong><strong>&nbsp;</strong>R<span style="color:black">etrospective cohort study of SAS pts who consecutively underwent pre-TAVI cardiac computed tomography (CCT) protocol (June 2022 -September 2024). Demographic data, clinical characteristics,&nbsp;transthoracic echocardiography (TTE), coronary angiography (CAG) and CCT parameters were collected. </span></span>Pts were followed from the date of the CCT until aortic valve replacement (AVR), death, or December 1, 2024, whichever occurred first (median follow-up: 8 months).&nbsp;<span style="color:#000000"><span style="color:black">Our pre-intervention&nbsp;endpoint was a composite of cardiovascular (CV) hospitalization, including due to heart failure (HF), all-cause mortality, and major adverse cardiovascular events (MACE), consisting of CV mortality, non-fatal acute myocardial infarction (AMI) and stroke. Pts aged &ge;85 years (group 1) were compared to those aged &lt;85 years (group 2).&nbsp;</span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:14px"><span style="font-family:Arial,Helvetica,sans-serif"><span style="color:#000000"><strong><span style="color:black">Results:</span></strong><strong>&nbsp;</strong><span style="color:black">A total of 189 pts underwent pre-TAVI CCT (98 males [52%]; mean age 81&plusmn;5 years). Of these, 52 pts (28%) were aged &ge;85 years (Group 1). Group 1 had a lower body mass index (27&plusmn;4vs.29&plusmn;5 kg/m&sup2;, p=0.038) and less frequent diabetes (25&nbsp;vs44%,p=0.018) but more frequent pacemaker implantation (23&nbsp;vs7%, p=0.001).&nbsp;CCT parameters were similar, except for a higher estimated left ventricular ejection fraction (LVEF) in Group 1 (66&plusmn;10&nbsp;vs61&plusmn;11%,p=0.033) and greater prevalence of mitral annulus calcification (23&nbsp;vs12%, p=0.049). Group 1 had less severe clinical presentation, including fewer New York Heart Association (NYHA) Class III&ndash;IV symptoms (12&nbsp;vs33%, p=0.005). CAG&nbsp;revealed less frequent multivessel coronary artery disease (CAD) in Group 1 (25&nbsp;vs58%, p=0.042) among pts with obstructive CAD. Overall, regarding treatment status, 7 pts were deemed unfit/declined TAVI, </span></span></span></span><span style="font-size:14px"><span style="font-family:Arial,Helvetica,sans-serif"><span style="color:#000000"><span style="color:black">16 had not completed pre-TAVI study,&nbsp;</span></span></span></span><span style="font-size:14px"><span style="font-family:Arial,Helvetica,sans-serif"><span style="color:#000000"><span style="color:black">9 were awaiting decision, 75 were awaiting intervention (69 for TAVI, 6 for surgical AVR&nbsp;[SAVR]), and 79 had undergone the treatment&nbsp;(74 TAVI, 5 SAVR). The median time from CCT to intervention&nbsp;was 9 [4&ndash;14] months. Pre-intervention&nbsp;outcomes were CV hospitalization (n=35), HF hospitalization (n=21), MACE [n= 9, including non-fatal strokes (n=4)&nbsp;and AMIs (n=1)], and all-cause mortality (n=20, including 8 CV-related deaths [40%]). No significant differences were observed in pre-intervention&nbsp;outcomes between the groups, however with a non-significant trend to higher all-cause mortality in group 1 (Fig. 1).&nbsp;</span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:14px"><span style="font-family:Arial,Helvetica,sans-serif"><span style="color:#000000"><strong><span style="color:black">Conclusion:&nbsp;</span></strong><span style="color:black">In our study, although<strong>&nbsp;</strong>very old pts awaiting TAVI presented less severe clinical presentation, lower diabetes prevalence, comparable pre-intervention hospitalization rates and CV events, a trend towards higher all-cause mortality was observed.&nbsp;</span></span></span></span></p>