Sarcopenia affects death risk after TAVI

Baseline sarcopenia worsens the 1-year mortality risk among patients undergoing transcatheter aortic valve implantation (TAVI), reports a recent study.

Drawing from a prospective, real-world registry from South Korea, the researchers enrolled 522 patients (mean age, 78.9±5.2 years; 49.4 percent male) who received TAVI for severe aortic stenosis. Routine computed tomography scans pre-TAVI were used to calculate skeletal muscle index (SMI), which in turn was used to determine sarcopenia. The primary outcome was 1-year all-cause mortality.

Participants were then classified into tertiles of SMI according to sex specific cut-offs (males: low, ≤38.9 cm²/m²; mid, 38.9 to ≤43.9 cm²/m²; high, >43.9 cm²/m²; females: low, ≤31.3 cm²/m²; mid, 31.3 to ≤36.8 cm²/m²; high, >36.8 cm²/m²).

After a median follow-up of 12.3 months, Kaplan-Meier curves estimated a 1-year all-cause mortality rate of 6.2 percent in the highest SMI tertile, 7.1 percent in the mid tertile, and 15.5 percent in the low tertile. The among-group difference was statistically significant (p=0.036).

Multivariable Cox proportional hazards analysis found that patients in the low SMI tertile had a more than twofold risk of 1-year mortality than their high-SMI comparators (hazard ratio [HR], 2.69, 95 percent confidence interval [CI], 1.18–6.12; p=0.019). The mid group saw no such effect.

SMI also did not significantly impact secondary clinical outcomes, including the risks for stroke, myocardial infarction, any rehospitalization, bleeding, acute kidney injuries, and vascular access site complications, among others.

“Physiological risk stratification with SMI as an adjunct to clinical and anatomical risk factors may be useful,” the researchers said. “Further researches are required to elucidate whether sarcopenic patients benefit from effective preventive and therapeutic strategies to counteract their frailty and improve their outcomes following TAVI.”