Shorter Time to Transcatheter Aortic Valve Implantation Is Associated With Improved Outcomes in Acute Decompensated Aortic Stenosis.

Background: Acute decompensated aortic stenosis is an increasingly common condition associated with a high rate of morbidity, mortality, and health care resource utilization. Among patients with acute decompensated aortic stenosis, this study aimed to assess the impact of time to transcatheter aortic valve implantation (TAVI) on outcomes, hypothesizing that longer durations are associated with worse outcomes.

Methods: Using a single-center registry, patients with their first presentation of acute decompensated aortic stenosis who underwent an urgent TAVI during their index admission were included. Time to TAVI was defined as the number of days between hospital admission and TAVI. The primary composite outcome was heart failure hospitalization or all-cause mortality. The secondary composite outcome was heart failure hospitalization or cardiovascular mortality.

Results: A total of 276 patients were included in this study: age 84 (79-88) years, male sex 63.7%, patients requiring cardiopulmonary organ support 3.6%, aortic valve area 0.7 (0.5-0.8) cm, and left ventricular ejection fraction 55 (37-57)%. Baseline characteristics were similar between patients stratified according to the median time to TAVI (22 [13-32] days). Over a follow-up of 4.6 (3.6-5.7) years, the primary and secondary outcomes occurred in 58% and 35% of patients, respectively. After adjusting for comorbidities, mean gradient, and cardiopulmonary organ support, time to TAVI was associated with both the primary (hazard ratio for every 5 days, 1.09 [95% CI, 1.04-1.16]; =0.001) and secondary outcomes (hazard ratio for every 5 days, 1.08 [95% CI, 1.01-1.16]; =0.023).

Conclusions: In patients with acute decompensated aortic stenosis, longer time to TAVI was associated with an increased risk of adverse events at mid-term follow-up.