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Prognostic impact of cancer history in patients undergoing transcatheter aortic valve implantation

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Abstract

Background

The benefit of TAVI in cancer patients is currently unclear.

Objectives

The purpose of this study is to investigate prognostic impact of cancer status (active cancer or previous cancer) in severe aortic stenosis (AS) patients undergoing transcatheter aortic valve implantation (TAVI).

Methods

Consecutive TAVI patients in the Heart Center Bonn were enrolled and we stratified the patients into three groups: current cancer (active cancer), non-current cancer (previous cancer), or no cancer. The primary outcome was all-cause death within a 5-year follow-up. We evaluated mean aortic pressure gradient (mPG) values following TAVI (baseline mPG) and at the final follow-up (follow-up mPG).

Results

In total, 1568 TAVI patients were eligible and 298 patients (19.0%) had active or previous cancer. At the 5-year follow-up, cancer patients had a significantly worse prognosis than non-cancer patients (log rank, P < 0.001). In a multivariable analysis, previous cancer was a significant predictor for 5-year mortality (hazard ratio [HR], 1.56; P < 0.001). Estimated mortality rates at 5-year follow-up rates among active cancer, previous cancer, and non-cancer were 84.0%, 65.8%, and 50.2% (long-rank P < 0.001), respectively. The hazard ratios of active cancer and previous cancer for 5-year mortality were 2.79 (P < 0.001) and 1.38 (P = 0.019) compared to non-cancer patients. We found significantly higher mPG during follow-up than at baseline in cancer patients (follow-up 8.10 vs baseline 7.40 mmHg; Wilcoxon P = 0.012).

Conclusions

Active, and also previous, cancer status are associated with less beneficial long-term prognosis in TAVI patients.

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Acknowledgements

We thank Ms. Meghan Campbell, a scientific coordinator in the Heart Center Bonn, for proofreading English.

Funding

Dr. Tabata was supported financially in part by the Fellowship of Astellas Foundation for Research on Metabolic Disorders and Uehara Memorial Foundation.

Author information

Authors and Affiliations

  1. Department of Medicine II, Heart Center Bonn, University Hospital Bonn, Sigmund-Freud-Str. 25, 53105, Bonn, Germany

    Noriaki Tabata, Baravan Al-Kassou, Atsushi Sugiura, Julian Kandt, Jasmin Shamekhi, Anja Stundl, Sebastian Zimmer, Hendrik Treede, Masanobu Ishii, Georg Nickenig, Nikos Werner & Jan-Malte Sinning

  2. Department of Cardiovascular Medicine Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan

    Noriaki Tabata & Kenichi Tsujita

Authors
  1. Noriaki Tabata
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  2. Baravan Al-Kassou
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Corresponding author

Correspondence to Jan-Malte Sinning.

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Conflicts of interest

Drs. Sinning, Werner, and Nickenig have received speaker honoraria and research grants from Abbott, Abiomed, Medtronic, Boston Scientific, and Edwards Lifesciences. Dr. Tsujita has received grants from Abbott Vascular Japan, Medtronic Japan, and Boston Scientific Japan. The other authors report no conflicts of interest.

Electronic supplementary material

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392_2020_1615_MOESM1_ESM.tiff

Supplementary Figure 1. Distribution of cancers in total subjects. The distribution of cancer diseases showed that prostate, breast, colorectal, leukemia, and bladder cancer had the highest prevalence (TIFF 26369 kb)

392_2020_1615_MOESM2_ESM.tiff

Supplementary Figure 2. Additional study flowchart. Cancer patients and non-cancer patients were matched by a propensity score matching method and were examined for baseline and follow-up mean pressure gradients. F.U., follow-up; TTE, transthoracic echocardiography (TIFF 26369 kb)

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Supplementary file7 (DOCX 29 kb)

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Tabata, N., Al-Kassou, B., Sugiura, A. et al. Prognostic impact of cancer history in patients undergoing transcatheter aortic valve implantation. Clin Res Cardiol 109, 1243–1250 (2020). https://doi.org/10.1007/s00392-020-01615-y

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  • DOI: https://doi.org/10.1007/s00392-020-01615-y

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