Elsevier

American Heart Journal

Volume 262, August 2023, Pages 100-109
American Heart Journal

Clinical Investigations
Mortality in patients with chronic obstructive pulmonary disorder undergoing transcatheter aortic valve replacement: The importance of chronic obstructive pulmonary disease exacerbation

https://doi.org/10.1016/j.ahj.2023.04.016Get rights and content
Under a Creative Commons license
open access

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.

Abbreviations

AE
Acute exacerbation
AS
Aortic stenosis
ATC
Anatomical therapeutic chemical classification system
CI
Confidence interval
COPD
Chronic obstructive pulmonary disease
GOLD
The global initiative for chronic obstructive lung disease
HR
Hazard ratio
ICD
International classification of diseases
ICS
Inhaled corticosteroid
IPW
Inverse probability of treatment weighting
LABA
Long-acting beta agonist
LAMA
Long-acting muscarinic antagonist
SABA
Short-acting beta agonist
SAMA
Short-acting muscarinic antagonist
SAVR
Surgical aortic valve replacement
TAVR
Transcatheter aortic valve replacement

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