Prognosis of patients with active cancer undergoing transcatheter aortic valve implantation: An insight from Japanese multicenter registry
Yoshimasa Kojima, Ryosuke Higuchi, Kenichi Hagiya, Mike Saji, Itaru Takamisawa, Nobuo Iguchi, Shuichiro Takanashi, Shinichiro Doi, Shinya Okazaki, Kei Sato, Harutoshi Tamura, Morimasa Takayama, Takanori Ikeda, Mitsuaki Isobe
Abstract
Malignancy is common in older adults undergoing transcatheter aortic valve implantation (TAVI), and may affect prognosis. The present study aimed to examine whether active cancer affects all-cause mortality rates among patients undergoing TAVI. This retrospective study examined data from 1,114 consecutive patients treated between April 2010 and June 2019. Patients with life expectancy of <1 year due to non-cardiac causes were excluded. Active cancer was defined as cancer under treatment or cured within 1 year, and was recognized in 62 patients (5.6%) with (n = 17) and without (n = 45) metastases. In multivariate analysis, being female (hazard ratio [HR] 0.55, 95% confidence interval [CI] 0.39–0.77, p < 0.001), body mass index (BMI) (HR = 0.92 per 1 kg/m2 increase, 95% CI 0.87–0.97, p = 0.001), New York Heart Association (NYHA) class III/IV (HR = 1.53, 95% CI 1.06–2.20, p = 0.022), atrial fibrillation (HR = 2.40, 95% CI 1.70–3.38, p < 0.001), albumin levels (HR = 0.41 per 1-g/dl, 95% CI 0.30–0.57, p < 0.001), and cancer metastasis (HR = 5.28, 95% CI 1.86–14.9, p = 0.001) were associated with all-cause mortality after TAVI. In patients undergoing TAVI, being female, high BMI, NYHA class III/IV, atrial fibrillation, albumin levels, and cancer metastasis were factors associated with mortality. Meanwhile, active cancer without metastasis was not associated with increased mortality rates. These findings would help clinical decision-making by patients and physicians. Clinical trial registration: UMIN000031133.