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Valvular heart disease
Original research
Inter-racial differences in patients undergoing transcatheter aortic valve implantation
  1. Do-Yoon Kang1,
  2. Jung-Min Ahn1,
  3. Juyong Brian Kim2,
  4. Alan Yeung2,
  5. Takeshi Nishi2,
  6. William Fearon2,
  7. Eric Page Cantey3,
  8. James D Flaherty3,
  9. Charles J Davidson3,
  10. S Christopher Malaisrie3,
  11. Seo Young Park4,
  12. Sung-Cheol Yun4,
  13. Euihong Ko1,
  14. Hanbit Park1,
  15. Seung-Ah Lee1,
  16. Dae-Hee Kim1,
  17. Ho Jin Kim5,
  18. Joon Bum Kim5,
  19. Suk Jung Choo5,
  20. Duk-Woo Park1,
  21. Seung-Jung Park1
  1. 1 Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
  2. 2 Department of Medicine, Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, California, USA
  3. 3 Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
  4. 4 Department of Clinical Epidemiology and Biostatistics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
  5. 5 Division of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
  1. Correspondence to Dr Duk-Woo Park, Cardiology, Asan Medical Center, Seoul 05505, Korea (the Republic of); dwpark{at}amc.seoul.kr

Abstract

Objective Little information exists about inter-racial differences in patients with aortic stenosis (AS) undergoing transcatheter aortic valve implantation (TAVI). We investigated whether differences in baseline characteristics between Asian and non-Asian population may contribute to disparities in clinical outcomes after TAVI.

Methods We performed a registry-based, multinational cohort study of patients with severe AS who underwent TAVI at two centres in the USA and one centre in South Korea. The primary outcome was a composite of death, stroke or rehospitalisation at 1 year.

Results Of 1412 patients, 581 patients were Asian and 831 were non-Asian (87.5% white, 1.7% black, 6.1% Hispanic or 4.7% others). There were substantial differences in baseline characteristics between two racial groups. The primary composite outcome was significantly lower in the Asian group than in the non-Asian group (26.0% vs 35.0%; HR 0.73; 95% CI 0.59 to 0.89; p=0.003). However, after adjustment of baseline covariates, the risk of primary composite outcome was not significantly different (HR 0.79; 95% CI 0.60 to 1.03; p=0.08). The all-cause mortality at 1 year was significantly lower in the Asian group than the non-Asian group (7.4% vs 12.5%; HR 0.60; 95% CI 0.41 to 0.88; p=0.009). After multivariable adjustment, the risk of all-cause mortality was also similar (HR 1.17; 95% CI 0.73 to 1.88; p=0.52).

Conclusions There were significant differences in baseline and procedural factors among Asian and non-Asian patients who underwent TAVI. Observed inter-racial differences in clinical outcomes were largely explained by baseline differences in clinical, anatomical and procedural factors.

Trial registration number NCT03826264 (https://wwwclinicaltrialsgov).

  • aortic valve stenosis
  • transcatheter aortic valve replacement
  • risk factors

Data availability statement

Data are available upon reasonable request.

https://doi.org/10.1136/heartjnl-2021-320364

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    Data availability statement

    Data are available upon reasonable request.

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    Footnotes

    • D-YK and J-MA are joint first authors.

    • Contributors D-WP and S-JP had full access to all the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. Guarantar—D-WP. Study concept and design—D-YK, J-MA, AY, JDF, D-WP and S-JP. Acquisition, analysis or interpretation of data—D-YK, J-MA, JBK, AY, WF, EPC, JDF, D-WP and S-JP. Drafting of the manuscript—D-YK, J-MA, D-WP and S-JP. Critical revision of the manuscript for important intellectual content—all authors. Statistical analysis—D-YK, SYP, S-CY and D-WP. Obtained funding—D-WP and S-JP. Administrative, technical or material support—D-YK, J-MA, JBK, AY, EPC, JDF, D-WP and S-JP. Study supervision—AY, JDF, D-WP and S-JP.

    • Funding This study was funded in part by the CVRF (Seoul, Korea; www.summitmd.com) and was supported by a grant (2020IF0016) from Asan Institute for Life Sciences and Corporate Relations of Asan Medical Center, Seoul, Korea with the NAVER Corp (Seongnam, Korea; www.navercorp.com/en).

    • Disclaimer The sponsors had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; and preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

    • Competing interests AC reported institutional research support from Edwards LifeSciences. WF reported institutional research support from Edwards LifeSciences. SCM reported support from Edwards LifeSciences, Medtronic, Cryolife and Terumo Aortic. D-WP reported receiving research grants, consulting and speaker fees from Edwards LifeSciences, Medtronic, Abbott and Daiichi Sankyo during the conduct of the study. S-JP reported receiving grants from Edwards LifeSciences, Medtronic and Abbott during the conduct of the study. No other disclosures were reported.

    • Provenance and peer review Not commissioned; internally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.