Should TAVR be Performed in Nonagenarians?

Although nonagenarians had higher mortality rates following transcatheter aortic valvle replacement (TAVR) than their younger counterparts, quality-of-life data at one year may suggest its efficacy for selected patients, according to a study published March 21 in the Journal of the American College of Cardiology. Using data from the STS/ACC TVT Registry, researchers examined records from 24,025 patients, of which 3,773 patients were 90 or older, from 329 hospitals between November 2011 and September 2014. Results showed that at 30 days, the mortality rate was higher in the nonagenarian group (8.8 percent) than in the younger group (5.9 percent), as it was at one year: 24.8 percent vs. 22 percent. There was not, however, a statistically significant difference in stroke incidence at 30 days (2.9 percent vs. 2.4 percent) or at one year (4.4 percent vs. 3.9 percent). The 30-day KCCQ-12 score was slightly lower in nonagenarians compared to younger patients but was similar at one year. Read more.

NCDR Study Finds Lower PCI Rates Correlate to Appropriate Use

Geographic areas that perform the lowest number of percutaneous coronary intervention (PCI) procedures also perform appropriate procedures had a higher rate than those that perform a greater number of PCI, according to a study published in PLOS ONE. Furthermore, as the rates of appropriate PCI decrease, they increase for inappropriate and uncertain procedures, as well as for procedures not correlated to appropriate use criteria (AUC) established by the American College of Cardiology, the American Heart Association, and the Society for Cardiovascular Angiography and Interventions. Using data from the ACC's CathPCI Registry linked with a limited dataset from Medicare, researchers assessed 2,010 records from 380,981 patients from 178 heath referral regions, or health care markets with at least one hospital performing major cardiovascular procedures and neurosurgery. These regions were divided into quintiles, with "1" representing the lowest utilization of PCI and "5" representing the highest. Results showed that when stratified by clinical status, the rates for appropriate PCI to treat acute conditions were high across all quintiles (range between 95 percent and 96 percent). For non-acute conditions, the rate of appropriate PCI decreased from 27 percent in quintile 1 to about 22 percent in quintile 5, and the rate of inappropriate PCI increased from almost 12 percent to almost 13 percent. The rate of uncertain procedures also increased, from 20 percent to 23 percent. There was no difference in risk-adjusted mortality across quintiles. Read more.

Association Viewpoints Homepage