重度主动脉瓣狭窄患者延迟超过6个月行TAVR与临床结局的关联

原文

Objective Early intervention for asymptomatic severe aortic stenosis (AS) has shown prognostic benefits; however, some patients undergo transcatheter aortic valve replacement (TAVR) after extended observation owing to mild symptoms or comorbidities. Although guidelines recommend surveillance of 6–12 months, the clinical implications of waiting beyond 6 months remain unclear. We assessed whether TAVR performed >6 months after the diagnosis of severe AS was associated with adverse outcomes. Methods We retrospectively analysed 149 patients who underwent TAVR for severe AS between January 2021 and December 2023. Patients were classified into early (≤6 months; n=100) and delayed (>6 months; n=49) groups. The primary endpoint was heart failure (HF) hospitalisation or all-cause mortality. Results Baseline characteristics were similar between the groups. During a median follow-up of 729 days, the primary endpoint occurred more frequently in the delayed group than in the early group (33% vs 16%, p=0.0134). This excess risk was largely attributable to non-cardiac mortality. In multivariable Cox regression, delayed intervention was independently associated with the primary endpoint (HR 3.47, 95% CI 1.61 to 7.47; p=0.0014); higher Clinical Frailty Scale scores were also associated with this endpoint (HR 1.62, 95% CI 1.07 to 2.42; p=0.0195). Conclusions TAVR performed 6 months after severe AS diagnosis was associated with a higher risk of HF hospitalisation or all-cause mortality, with the excess risk predominantly attributable to non-cardiac mortality. These findings emphasise the need for careful clinical surveillance and may support more frequent reassessment in selected high-risk patients.