Prevalence and Consequences of Guideline-Directed Indications for Aortic Valve Replacement in the EARLY TAVR Trial.

What was studied

This analysis used the EARLY TAVR trial. It involved people with severe aortic stenosis who had no symptoms. They were assigned by chance to TAVR or to clinical surveillance. TAVR is valve replacement through a vessel. People under surveillance could switch to TAVR when main guideline indications appeared. The team split people by whether they had extra guideline indications at the start. The main outcome was death, stroke or a hospital stay for heart failure.

What they found

901 people were assigned: 445 to TAVR and 446 to surveillance. 636 had no guideline indication at the start. 265 had at least 1 extra indication. Follow-up lasted 3.8 years at the median. People with an extra indication had higher rates of the main outcome. The hazard ratio was 1.78. They also tended to have acute valve syndrome when they switched. Early TAVR gave a similar benefit with or without an extra indication.

What it means for patients

The authors say extra guideline indications were present in some people at the start. They say the benefit of early TAVR was similar with or without them. They say this supports early TAVR over surveillance. This applies to severe disease without symptoms.

Why it is not certain yet

This was an analysis of subgroups within one trial. The range around one benefit estimate was wide, from 0.37 to 1.02. Subgroup analyses are less firm than a trial main result. The follow-up time was 3.8 years at the median.

Source

Prevalence and Consequences of Guideline-Directed Indications for Aortic Valve Replacement in the EARLY TAVR Trial.

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