TY - JOUR
T1 - Mortality in patients with chronic obstructive pulmonary disorder undergoing transcatheter aortic valve replacement
T2 - The importance of chronic obstructive pulmonary disease exacerbation
AU - Lauridsen, Marie Dam
AU - Valentin, Jan Brink
AU - Strange, Jarl Emanuel
AU - Jacobsen, Peter A
AU - Køber, Lars
AU - Weinreich, Ulla
AU - Johnsen, Søren Paaske
AU - Fosbøl, Emil
N1 - Copyright © 2023. Published by Elsevier Inc.
PY - 2023/8
Y1 - 2023/8
N2 - BACKGROUND: Severe chronic obstructive pulmonary disease (COPD) has been associated with futile outcome after transcatheter aortic valve replacement (TAVR). Data on outcomes according to COPD severity are warranted to aid identification of patients who may not benefit from TAVR. We aimed to examine the association between risk of COPD exacerbation and 1-year mortality after TAVR.METHODS: Using Danish nationwide registries we identified patients undergoing first-time TAVR during 2008‒2021 by COPD status. COPD severity levels were defined as low or high risk of acute exacerbation of COPD (AE-COPD) and treatment intensity levels (none or short-term, mono/dual, triple therapy, or home oxygen). Kaplan-Meier functions and adjusted Cox regression models were used to assess 1-year mortality comparing COPD severity groups with patients without COPD.RESULTS: We identified 7,047 patients with TAVR of whom 644 had a history of COPD (low risk of AE-COPD: 439, high risk of AE-COPD: 205). The median age of the TAVR cohort was 81.4 years (IQR: 76.8‒85.1) and 55.8% were males. One-year mortality for TAVR patients without COPD was 8.5% (95% CI: 7.8‒9.2) and 15.4% (95% CI: 12.5‒18.2) for those with COPD (adjusted HR: 1.63 (95% CI: 1.28‒2.07)). Patients with low or high risk of AE-COPD had 1-year mortality of 13.1% (95% CI: 9.8‒16.3) and 20.2% (95% CI: 14.6‒25.8) corresponding to adjusted HRs of 1.31 (95% CI: 0.97‒1.78) and 2.44 (95% CI: 1.70‒3.50) compared with patients without COPD. Patients with high risk of AE-COPD and no/short term therapy or use of home oxygen represented the subgroups of patients with the highest 1-year mortality (31.6% (95% CI: 14.5‒48.7) and 30.9% (95% CI: 10.3‒51.6)).CONCLUSION: Among patients undergoing TAVR, increasing risk of exacerbation with COPD was associated with increasing 1-year mortality compared with non-COPD patients. Patients with a high risk of exacerbation with COPD not using any guideline recommended COPD medication and those using home oxygen had the highest 1-year mortality.
AB - BACKGROUND: Severe chronic obstructive pulmonary disease (COPD) has been associated with futile outcome after transcatheter aortic valve replacement (TAVR). Data on outcomes according to COPD severity are warranted to aid identification of patients who may not benefit from TAVR. We aimed to examine the association between risk of COPD exacerbation and 1-year mortality after TAVR.METHODS: Using Danish nationwide registries we identified patients undergoing first-time TAVR during 2008‒2021 by COPD status. COPD severity levels were defined as low or high risk of acute exacerbation of COPD (AE-COPD) and treatment intensity levels (none or short-term, mono/dual, triple therapy, or home oxygen). Kaplan-Meier functions and adjusted Cox regression models were used to assess 1-year mortality comparing COPD severity groups with patients without COPD.RESULTS: We identified 7,047 patients with TAVR of whom 644 had a history of COPD (low risk of AE-COPD: 439, high risk of AE-COPD: 205). The median age of the TAVR cohort was 81.4 years (IQR: 76.8‒85.1) and 55.8% were males. One-year mortality for TAVR patients without COPD was 8.5% (95% CI: 7.8‒9.2) and 15.4% (95% CI: 12.5‒18.2) for those with COPD (adjusted HR: 1.63 (95% CI: 1.28‒2.07)). Patients with low or high risk of AE-COPD had 1-year mortality of 13.1% (95% CI: 9.8‒16.3) and 20.2% (95% CI: 14.6‒25.8) corresponding to adjusted HRs of 1.31 (95% CI: 0.97‒1.78) and 2.44 (95% CI: 1.70‒3.50) compared with patients without COPD. Patients with high risk of AE-COPD and no/short term therapy or use of home oxygen represented the subgroups of patients with the highest 1-year mortality (31.6% (95% CI: 14.5‒48.7) and 30.9% (95% CI: 10.3‒51.6)).CONCLUSION: Among patients undergoing TAVR, increasing risk of exacerbation with COPD was associated with increasing 1-year mortality compared with non-COPD patients. Patients with a high risk of exacerbation with COPD not using any guideline recommended COPD medication and those using home oxygen had the highest 1-year mortality.
UR - http://www.scopus.com/inward/record.url?scp=85159209302&partnerID=8YFLogxK
U2 - 10.1016/j.ahj.2023.04.016
DO - 10.1016/j.ahj.2023.04.016
M3 - Journal article
C2 - 37116603
SN - 0002-8703
VL - 262
SP - 100
EP - 109
JO - American Heart Journal
JF - American Heart Journal
ER -