Early TAVR shows the greatest reduction in stroke rates in patients aged 65 to 70

Early TAVR shows the greatest reduction in stroke rates in patients aged 65 to 70

A new analysis from the early TAVR trial found that patients aged 65 to 70 years had the greatest benefit from an early intervention strategy with transcatheter aortic valve replacement (TAVR) compared to other age groups, particularly in terms of stroke risk and in relation to the association with death, stroke and heart failure, and in the hospital failure. The late results were presented today at the Society for Cardiovascular Angiography and Interventions (SCAI) 2025 Scientific Sessions.

Up to 300,000 Americans are diagnosed each year, a serious condition that occurs when the aortic valve in the heart becomes narrowed or blocked. Two strategies for the treatment of asymptomatic severe indications that are typically carried out. Clinical surveillance (CS) with routine monitoring and aortic valve replacement only if symptoms developed or aortic valve replacement. In patients with asymptomatic, severe AS, the early TAVR trial demonstrated that an early TAVR strategy was superior to CS for the primary endpoint of death, stroke, or unplanned cardiovascular hospitalization. This data presentation provides the first report from the randomized, controlled early TAVR trial on whether a patient's age should influence decision-making about procedural timing for patients with asymptomatic, severe AS.

The main objectives of the study were to quantify death, stroke and unexpected cardiovascular hospitalizations. The researchers found 901 patients with asymptomatic severe AS and placed 455 in an early TAVR group and 446 in a CS group. The average follow-up time was 3.8 years. Baseline characteristics and health status were similar between treatment groups.

Older age was associated with higher rates of death, stroke, or HF hospitalizations up to five years after expansion for both patient groups. Early TAVR demonstrated advantages over CS in all age groups. Patients aged 65 to 69 years who underwent early TAVR achieved the most benefits with a significant reduction in stroke risk (0% early TAVR vs. 13% CS) and had a six-fold lower rate of death, stroke, or HF hospitalization compared to patients who underwent CS (4.7% vs. 25.6%) up to five years after expansion of CS (4.7% vs. 25.6%). Patients over 80 years of age also achieved the greatest benefit in stroke risk, with the early TAVR strategy associated with a 4-fold reduction in 5-year stroke compared with clinical surveillance.

These results are important and highlight the benefits of early intervention in younger patients with asymptomatic severe aortic stenosis, particularly in relation to the risk of stroke, a complication most feared by patients. We are discovering that aortic stenosis itself could be an important risk factor of stroke if left untreated. Putting everything together and considering the benefits and lack of risks in patients at least 65 years or more, early TAVR should be preferred over clinical surveillance in all age groups. “

Philippe Genereux, MD, director of the Structural Heart Program at the Gagnon Cardiovascular Institute at Morristown Medical Center, Morristown, New Jersey, principal investigator of the early TAVR trial and senior author of the study

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