Valvular & structural heart diseaseResearch article
Age and Procedural Timing for Asymptomatic Severe Aortic Stenosis: Analysis From the EARLY Transcatheter Aortic Valve Replacement (TAVR) Trial
- Analysis From the EARLY TAVR Trial
- stratified into 4 age groups
- interaction tests
Authors' conclusion
In the EARLY TAVR trial, the relative benefit of early TAVR over CS was consistent among all age groups. The greatest absolute reduction in stroke rate with early TAVR compared with CS appeared in the youngest and oldest groups, whereas reduction in heart failure hospitalization was most pronounced in the oldest patients. These data suggest that early TAVR should be considered in all age groups above 65 years.
Study context
- Population
- Patients with asymptomatic severe aortic stenosis in the EARLY TAVR trial, stratified by agestratified into 4 age groups · 65 to 69 years 141 · 70 to 74 years 263 · 75 to 79 years 250 · ≥80 years 247
- Comparison
- whether the treatment effect of early TAVR versus clinical surveillance (CS) differed by age
- Outcome
- trial primary end point of death, stroke, or unplanned cardiovascular hospitalization, by age
Main finding
As reported in the abstract
- No interaction was detected between age and the treatment effect of early TAVR versus CS for the composites or individual outcomes
Further findings
| Outcome | absolute risk reduction | P value |
|---|---|---|
| Stroke, by age group — early TAVR vs CS · 65-69 years; lower stroke rates with early TAVR | 13% | P = 0.008 |
| Stroke, by age group — early TAVR vs CS · ≥80 years; lower stroke rates with early TAVR | 12.3% | P = 0.029 |
Heart failure hospitalization, absolute difference between early TAVR and CS arms, by age group · 2 years
- ≥80 years
- 9.1%
- 75-79 years
- 5.9%
- 70-74 years
- 5.1%
- 65-69 years
- 4.4%
- greatest in the oldest patients
Time to conversion to AVR in the CS group
- similar across all age groups (median)
- 11 months
- P =0.73
Acute valve syndrome at conversion in the CS arm
- frequency tended to increase with age
- P = 0.06
- Approximately one-third of younger patients (65-69 years) in the CS arm
Original publication
Summarised from the published abstract; every number is checked against it