Temporal Trends and Outcomes of Transcatheter versus Surgical Aortic Valve Replacement in Patients with Prior Myocardial Infarction

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Background: There is a paucity of data regarding the comparative safety and effectiveness of transcatheter aortic valve replacement (TAVR) versus surgical aortic valve replacement (SAVR) in patients with prior myocardial infarction (MI). Methods: We queried the NIS database (2012–2016) to identify patients with a prior history of MI who underwent isolated AVR. We conducted a propensity matching analysis comparing patients with TAVR versus SAVR based on patient demographics, comorbidities and hospital characteristics. The primary outcome was in-hospital mortality. Results: Among 24,090 hospitalizations with prior MI undergoing isolated AVR, 58.5% underwent TAVR. Over the study period, there was an increase in the proportion of patients undergoing TAVR and a decrease in patients undergoing SAVR (Ptrend<0.001). After propensity matching, in-hospital mortality was not different between TAVR and SAVR (odds ratio 1.07; 95% confidence interval 0.85–1.33). Compared with SAVR, TAVR was associated with lower rates of cardiac arrest, cardiogenic shock, acute kidney injury, respiratory complications, postoperative bleeding, blood transfusion, acute stroke, vascular complications and shorter length of stay. TAVR was associated with a higher incidence of complete heart block and pacemaker implantation. Conclusion: In this nationwide observational study, there has been a steady increase in the number of TAVRs performed in patients with prior MI. Compared with SAVR, TAVR was associated with similar in-hospital mortality and a lower rate of complications and length of stay.

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