Racial Differences in the Incidence and Impact of Prosthesis-Patient Mismatch After Transcatheter Aortic Valve Replacement,JACC: Cardiovascular Interventions

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Racial Differences in the Incidence and Impact of Prosthesis-Patient Mismatch After Transcatheter Aortic Valve Replacement
JACC: Cardiovascular Interventions ( IF 11.7 ) Pub Date : 2021-11-24 , DOI: 10.1016/j.jcin.2021.08.038
Hanbit Park ₁ , Jung-Min Ahn ₁ , Do-Yoon Kang ₁ , Juyong Brian Kim ₂ , Alan C Yeung ₂ , Takeshi Nishi ₂ , William F Fearon ₂ , Eric Page Cantey ₃ , James D Flaherty ₃ , Charles J Davidson ₃ , S Christopher Malaisrie ₃ , Sehee Kim ₄ , Sung-Cheol Yun ₄ , Euihong Ko ₁ , Seung-Ah Lee ₁ , Dae-Hee Kim ₁ , Ho Jin Kim ₅ , Joon Bum Kim ₅ , Suk Jung Choo ₅ , Duk-Woo Park ₁ , Seung-Jung Park ₁

Affiliation

Objectives

The aim of this study was to compare the incidence and prognostic significance of prosthesis-patient mismatch (PPM) after transcatheter aortic valve replacement (TAVR) according to racial groups.

Background

PPM after TAVR may be of more concern in Asian populations considering their relatively small annular and valve sizes compared with Western populations.

Methods

TP-TAVR (Transpacific TAVR Registry) was an international multicenter cohort study of patients with severe aortic stenosis who underwent TAVR in the United States and South Korea from January 2015 to November 2019. PPM was defined as moderate (0.65-0.85 cm²/m²) or severe (<0.65 cm²/m²) at the indexed effective orifice area. The primary outcome was a composite of death, stroke, or rehospitalization at 1 year.

Results

Among 1,101 eligible patients (533 Asian and 569 non-Asian), the incidence of PPM was significantly lower in the Asian population (33.6%; moderate, 26.5%; severe, 7.1%) than in the non-Asian population (54.5%; moderate, 29.8%; severe, 24.7%). The 1-year rate of the primary outcome was similar between the PPM and non-PPM groups (27.5% vs 28.1%; P = 0.69); this pattern was consistent between Asian (25.4% vs 25.2%; P = 0.31) and non-Asian (28.7% vs 32.1%; P = 0.97) patients. After multivariable adjustment, the risk for the primary outcome did not significantly differ between the PPM and non-PPM groups in the overall population (HR: 0.95; 95% CI: 0.74-1.21), in Asian patients (HR: 1.07; 95% CI: 0.74-1.55), and in non-Asian patients (HR: 0.86; 95% CI: 0.63-1.19).

Conclusions

In this study of patients with severe aortic stenosis who underwent TAVR, the incidence of PPM was significantly lower in Asian patients than in non-Asian patients. The 1-year risk for the primary composite outcome was similar between the PPM and non-PPM groups regardless of racial group. (Transpacific TAVR Registry [TP-TAVR]; NCT03826264)

中文翻译：

经导管主动脉瓣置换术后假体与患者不匹配的发生率和影响的种族差异

目标

本研究的目的是根据种族比较经导管主动脉瓣置换术 (TAVR) 后假体与患者不匹配 (PPM) 的发生率和预后意义。

背景

考虑到与西方人群相比，亚洲人群的瓣环和瓣膜尺寸相对较小，TAVR 后的 PPM 可能在亚洲人群中更受关注。

方法

TP-TAVR（Transpacific TAVR Registry）是一项国际多中心队列研究，研究对象为 2015 年 1 月至 2019 年 11 月在美国和韩国接受 TAVR 的严重主动脉瓣狭窄患者。PPM 定义为中度（0.65-0.85 cm ² /m ² ) 或严重 (<0.65 cm ² /m ² ) 在索引有效孔口区域。主要结局是 1 年时死亡、卒中或再次住院的复合结局。

结果

在 1,101 名符合条件的患者（533 名亚裔和 569 名非亚裔）中，亚裔人群的 PPM 发生率（33.6%；中度，26.5%；重度，7.1%）显着低于非亚裔人群（54.5%；中度，29.8%；重度，24.7%）。PPM 组和非 PPM 组的 1 年主要结局发生率相似（27.5% vs 28.1%；P = 0.69）；这种模式在亚裔（25.4% 对 25.2%；P = 0.31）和非亚裔（28.7% 对 32.1%；P = 0.97）患者之间是一致的。多变量调整后，在亚洲患者（HR：1.07；95%）中，PPM 组和非 PPM 组的主要结局风险在总体人群（HR：0.95；95% CI：0.74-1.21）之间没有显着差异CI：0.74-1.55）和非亚洲患者（HR：0.86；95% CI：0.63-1.19）。