When Real-World Outcomes Do Not Meet the Results of Clinical Trials: Transfemoral Transcatheter vs. Surgical Aortic Valve Replacement in an Intermediate-Age Population (The Outstanding Italy Study)
Rattachement africain : it. Niveau de preuve : code pays fourni par la source.
Le résumé fourni par la source
Objective: Aortic valve stenosis is the most common valvular heart disease in the elderly, and its treatment may be either surgical (SAVR) or transcatheter (TAVI). Although age is one of the main determinants of the therapeutic choice, current guidelines leave a “discrepancy area” between 65 and 75 years, with the American guidelines allowing TAVI for patients older than 65 years, while the European guidelines consider TAVI for patients older than 75 years. The present study addresses the outcomes of SAVR vs. TAVI in a real-world population aged 65 to 80 years, that is, one largely inclusive of the discrepancy area. Methods: This is a retrospective registry study based on data retrieved from administrative health databases of two large Italian regions (Lombardy and Puglia). Patients aged 65 to 80 years receiving either SAVR or a TAVI between 2018 and 2021 were selected. SAVR and TAVI outcomes (death, cardiac and non-cardiac events) were compared using a propensity-matching analysis, with a follow-up of 2 to 5 years and mortality as the primary outcome. Results: After propensity matching, two groups of 786 patients were compared in Lombardy and two groups of 321 patients were compared in Puglia. In both regions, at the end of follow-up, mortality was significantly (p < 0.001) lower in SAVR vs. TAVI (24.6% vs. 47.2% in Lombardy and 18.1% vs. 44.1% in Puglia). Conclusions: Our results are in contrast with the randomized controlled trials showing equivalence or even the superiority of TAVI vs. SAVR, but in agreement with other registry studies based on real-world data. With respect to the randomized controlled trials, the main difference is a better outcome in SAVR. Caution should be applied in addressing patients < 80 years with TAVI unless SAVR is contraindicated.
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Le contrôle bibliographique ouvert
DOI retrouvé dans Crossref DOI retrouvé ; titre concordant.
- Titre Crossref
- When Real-World Outcomes Do Not Meet the Results of Clinical Trials: Transfemoral Transcatheter vs. Surgical Aortic Valve Replacement in an Intermediate-Age Population (The Outstanding Italy Study)
- Date Crossref
- 15/05/2025
- Éditeur
- MDPI AG
- Type
- journal-article
Ce recoupement confirme des métadonnées liées au DOI. Il ne confirme ni la méthode ni les conclusions de l’étude, et il ne compte pas comme une seconde source scientifique indépendante.
Où se fait cette recherche
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IRCCS Policlinico San Donato Department of Cardiovascular Anesthesia and Intensive Care pays non établi dans la noticeÉtablissement de santé
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Mario Negri Institute for Pharmacological Research pays non établi dans la noticeOrganisation à but non lucratif
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Agenzia Regionale Sanitaria della Puglia pays non établi dans la noticeOrganisme public
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Policlinico San Matteo Fondazione pays non établi dans la noticeÉtablissement de santé
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Istituti di Ricovero e Cura a Carattere Scientifico pays non établi dans la noticeÉtablissement de santé
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University of Milan Department of Medicine and Surgery pays non établi dans la noticeUniversité ou école supérieure
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Centro Cardiologico Monzino pays non établi dans la noticeÉtablissement de santé
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Istituti Clinici Scientifici Maugeri Department of Cardiology pays non établi dans la noticeÉtablissement de santé
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Vita-Salute San Raffaele University pays non établi dans la noticeUniversité ou école supérieure
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Istituto di Ricovero e Cura a Carattere Scientifico San Raffaele pays non établi dans la noticeÉtablissement de santé
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IRCCS Istituto Auxologico Italiano pays non établi dans la noticeÉtablissement de santé
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University of Milano-Bicocca pays non établi dans la noticeUniversité ou école supérieure
Department of Cardiovascular Anesthesia and Intensive Care — IRCCS Policlinico San Donato, Mario Negri Institute for Pharmacological Research et Agenzia Regionale Sanitaria della Puglia, avec 9 autres affiliations.
Une affiliation ne permet pas de déduire la nationalité d’un auteur.