Intermediate Risk Trial

PARTNER IIA Trial - TAVI shows similar outcomes compared to sAVR1

Clinician-with-patient

The PARTNER IIA Trial study design1

Partner IIA study design graph

Inclusions1

  • Severe aortic valve stenosis

    • Aortic valve area <0.8 cm2 or AVA index <0.5 cm2/m2
    • Mean gradient >40 mmHg or jet velocity >4.0 m/s
  • Symptoms of AS (NYHA class ≥II)
  • Intermediate surgical risk (STS score ≥4% and decision by a Heart Team)

Exclusions1

 

  • Heart Team assessment of inoperability
  • Evidence of an acute myocardial infarction ≤1 month (30 days) before the intended treatment
  • Aortic valve is a congenital unicuspid or congenital bicuspid valve, or is noncalcified
  • Other anatomical or clinical features that increased the risk of complications associated with either TAVI or sAVR or factors that could confound the results

The baseline characteristics of the patients in the TAVI and sAVR groups were generally well balanced in the two groups with the exception of higher peripheral vascular disease (27.9% vs 32.9%, p=0.02) and atrial fibrillation (31.0 vs 35.2%, p=0.05) in the sAVR group.1*
TAVI (n=1,011)
sAVR (n=1,021)
Age
81.5 ± 6.7
81.7 ± 6.7
Male
54.2%
54.8%
BMI – kg / m2†
28.6 ± 6.2
28.3 ± 6.2
STS score
5.8 ± 2.1
5.8 ± 1.9
NYHA (III or IV)
77.3%
76.1%
Coronary artery disease
69.2%
66.5%
Peripheral vascular disease
27.9%
32.9%
Diabetes
37.7%
34.2%
COPD
31.8%
30.0%
Creatinine > 2 mg/dL§
5.0%
5.2%
Frailty condition
5-Meter walk-test time > 7 sec
44.4%
46.4%
Serum albumin < 3.5 g/dl
15.2%
14.7%
Atrial fibrillation
31.0%
35.2%
Permanent pacemaker
11.7%
12.0%
Liver disease
1.9%
2.5%
TAVI (n=1,011)
Age
Male
BMI – kg / m2†
STS score
NYHA (III or IV)
Coronary artery disease
Peripheral vascular disease
Diabetes
COPD
Creatinine > 2 mg/dL§
Frailty condition
5-Meter walk-test time > 7 sec
Serum albumin < 3.5 g/dl
Atrial fibrillation
Permanent pacemaker
Liver disease
TAVI (n=1,011)
sAVR (n=1,021)
81.5 ± 6.7
81.7 ± 6.7
54.2%
54.8%
28.6 ± 6.2
28.3 ± 6.2
5.8 ± 2.1
5.8 ± 1.9
77.3%
76.1%
69.2%
66.5%
27.9%
32.9%
37.7%
34.2%
31.8%
30.0%
5.0%
5.2%
44.4%
46.4%
15.2%
14.7%
31.0%
35.2%
11.7%
12.0%
1.9%
2.5%
Plus–minus values are means ±SD. The body-mass index is the weight in kilograms divided by the square of the height in metres. Scoring on the risk model of the Society of Thoracic Surgeons (STS) uses an algorithm that is based on the presence of coexisting illnesses in order to predict 30-day operative mortality. The STS score equals the predicted mortality expressed as a percentage. Less than 5% of patients in the population on which the STS algorithm is based had a predicted operative mortality (risk score) of more than 10%. To convert values for creatinine to micromoles per litre, multiply by 88.4.

Reported clinical and patient outcomes

Quality of life

Patients receiving transfemoral TAVI enjoyed an improved health status through 2 years of follow-up after the procedure from baseline, as measured using the KCCQ-OS (Kansas City Cardiomyopathy Questionnaire – Overall Summary)2

Quality of life - intermediate risk patients

Real-world setting

TAVI has demonstrated similar efficacy in intermediate-risk patients to clinical trials3,4

 

  • ACC/STS TVT Registry: Propensity score matched 30-day outcomes showed no differences in all-cause mortality, all strokes and rates of new pacemakers between the ACC/STS TVT Registry, the PARTNER II S3i Trial and the S3i continued access registry3
  • SOLACE AU Registry: At 1 year, the rates of death, major vascular complications, acute kidney injury, life-threatening or disabling bleeding, and reintervention were 8.6%, 3.0%, 1.25%, 1.1% and 1.5% respectively4

Clinical implications

What could a TAVI referral mean for your patients who match the PARTNER IIA Trial characteristics?

  • Lowering your patients’ risk of death or disabling stroke through 2 years vs sAVR1
  • A speedy recovery to help patients to get back to the life they love1
  • Meaningful, early and late health status benefits which could give your patients the opportunity for a fuller life2

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References

  • 1Leon MB, et al. N Engl J Med 2016;374:1609-1620 and supplementary material.
  • 2 Baron SJ, et al. JAMA Cardiol 2017;2(8) 837-845.
  • 3 Tuzcu M. Presentation at EuroPCR, May 22‒25, 2018; Paris, France.
  • 4 Walters D, et al. JACC 2016;68(18):B275‒B276.

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