Prosthesis-Patient Mismatch and Patient-Centered Outcomes After TAVR.
Ottavia Cozzi, Daijiro Tomii, Jonas Lanz et al.
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In 30 seconds
This post hoc analysis of the multicentre SCOPE I randomised trial examined whether prosthesis-patient mismatch (PPM) severity after transcatheter aortic valve replacement was associated with survival and patient-reported health status through 3 years. Among 662 patients, mortality did not differ across PPM categories. At 3 years, severe PPM was associated with lower health-status scores and fewer patients alive with good health status than no PPM (30.6% vs 49.4%; P = 0.021). The association with the integrated outcome was no longer statistically significant after adjustment for 30-day mitral regurgitation; the authors consider the findings hypothesis-generating.
Key findings
- Moderate PPM occurred in 184 (27.8%) patients and severe PPM in 69 (10.4%).
- All-cause mortality at 1 and 3 years was 7.0% and 20.5%, with no differences across PPM categories.
- At 3 years, median KCCQ Overall Summary scores were 71.1 with severe PPM and 83.9 with no PPM (P = 0.027).
- Fewer patients with severe PPM were alive with good health status at 3 years than those with no PPM (30.6% vs 49.4%; P = 0.021).
Why it matters
The findings suggest that PPM severity may relate to longer-term patient-reported health even when mortality is similar across categories. Assessing outcomes that combine survival and health status can therefore reveal differences not captured by mortality alone. The attenuation of the association after accounting for residual mitral regurgitation also highlights the need to interpret the relationship cautiously.
What to keep in mind
This was a post hoc analysis, so the findings are hypothesis-generating and do not establish that PPM causes poorer health status.