Outcomes of patients with active cancer after transcatheter aortic valve replacement: an updated meta-analysis.

Autor: Felix N; Division of Medicine, Federal University of Campina Grande, 795 Juvêncio Arruda Avenue, Campina Grande, Brazil. nicole.santos@estudante.ufcg.edu.br., Nogueira A; Division of Medicine, Bahiana School of Medicine and Public Health, Salvador, Brazil., Carvalho PEP; Center for Coronary Artery Disease, Minneapolis Heart Institute Foundation, Minneapolis, USA., Costa TA; Department of Medicine, University of Colorado School of Medicine, Aurora, CO, USA., Tramujas L; Hcor Research Institute, São Paulo, Brazil., Generoso G; Division of Cardiology, Hospital Sírio-Libanês, São Paulo, Brazil., Feldman S; Division of Cardiology, Department of Internal Medicine, Weill Cornell Medicine, New York, NY, USA., Garot P; Institut Cardiovasculaire Paris Sud (ICPS), Hôpital Jacques Cartier, Ramsay-Santé, Massy, France., de Farias MDCAD; Division of Medicine, Federal University of Campina Grande, 795 Juvêncio Arruda Avenue, Campina Grande, Brazil.
Jazyk: angličtina
Zdroj: Cardio-oncology (London, England) [Cardiooncology] 2024 Sep 02; Vol. 10 (1), pp. 55. Date of Electronic Publication: 2024 Sep 02.
DOI: 10.1186/s40959-024-00256-8
Abstrakt: Background: Patients with active cancer and aortic stenosis may be under-referred for valve interventions due to concerns over a prohibitive risk. However, whether active cancer impacts outcomes after transcatheter aortic valve replacement (TAVR) remains unknown.
Methods: We searched PubMed, Embase, and Cochrane Library in December 2023 for studies comparing the post-TAVR outcomes of patients with versus without active cancer. We pooled odds ratios (OR) and adjusted hazard ratios (aHR) with 95% confidence intervals (CI) applying a random-effects model. Statistical analyses were performed in R version 4.3.2.
Results: We included nine observational studies analyzing 133,906 patients, of whom 9,792 (7.3%) had active cancer. Compared with patients without cancer, patients with active cancer had higher short- (OR 1.33; 95% CI 1.15-1.55; p < 0.001) and long-term mortality (OR 2.29; 95% CI 1.80-2.91; p < 0.001) rates, not driven by cardiovascular mortality (OR 1.30; 95% CI 0.70-2.40; p = 0.40), and higher major bleeding rates (OR 1.66; 95% CI 1.15-2.42; p = 0.008). The higher mortality rate was sustained in an adjusted analysis (aHR 1.77; 95% CI 1.34-2.35; p < 0.001). There was no significant difference in cardiac, renal, and cerebral complications at a follow-up ranging from 180 days to 10 years.
Conclusion: Patients with active cancer undergoing TAVR had higher non-cardiovascular mortality and bleeding rates, with comparable incidences of other complications. This highlights the need for a shared decision and appropriate patient selection considering cancer type, staging, bleeding risk, and optimal timing for intervention.
(© 2024. The Author(s).)
Databáze: MEDLINE
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