Abstract EP11: Long-term Outcomes Of Transcatheter Aortic Valve Replacement Compared With Surgical Aortic Valve Replacement: A Retrospective Cohort Study With Overlap Propensity Score Weighting
Bibliographic record
Abstract
Objectives: This longitudinal observational study utilized surgical procedure data from Ontario, Canada to compare mid- and long-term clinical outcomes in a representative real-world cohort of patients (2007-2019) after transcatheter aortic valve replacement (TAVR) and surgical aortic valve replacement (SAVR). Methods: A novel overlap weighting propensity score method was used to match patients on the date of TAVR or SAVR, conditional on baseline patient characteristics. Primary outcomes were all-cause and cardiovascular mortality either in-hospital or at 1, 3 and 5 years post-discharge. Secondary outcomes included ischemic stroke, hemorrhagic stroke, myocardial infarction, acute kidney injury, vascular complications, atrial fibrillation, endocarditis, permanent pacemaker implantation, defibrillator, reintervention, and cause-specific readmission at 1, 3 and 5 years post-discharge. In-hospital outcomes were compared using multivariable logistic regression. Long-term primary and secondary outcomes for patients undergoing TAVR vs. SAVR were compared using an overlap propensity score-weighted competing risks sub-distribution proportional hazards model. Results: The study included 9,355 SAVR and 2,641 TAVR patients. Hazards of all-cause mortality at 1 year (Hazard Ratio [HR], 1.25; 95% CI, 1.06-1.48), 3 years (HR, 1.48; 95% CI, 1.31-1.68) and 5 years (HR, 1.51; 95% CI, 1.36-1.69) were significantly higher in the TAVR compared to SAVR group. Cardiovascular mortality was significantly higher in the TAVR group at 3 (HR, 1.40; 95% CI, 1.08-1.80) and 5 years (HR, 1.41; 95% CI, 1.13-1.77). Non-cardiovascular mortality was also significantly higher in the TAVR group at 1 year (HR, 1.46; 95% CI, 1.03-2.06), 3 years (HR, 1.48; 95% CI, 1.17-1.88), and 5 years (HR, 1.41; 95% CI, 1.16-1.72). Hazards of myocardial infarction were significantly greater in the TAVR at 1 year (HR, 1.72; 95% CI, 1.08-2.74), 3 years (HR, 1.86; 95% CI, 1.35-2.57), and 5 years (HR, 1.82; 95% CI, 1.37-2.42). Hazards of angina readmission were significantly greater in the TAVR at 3 years (HR, 1.94; 95% CI, 1.26-3.00) and 5 years (HR, 1.87; 95% CI, 1.26-2.78). Conclusions: In real-life patients who underwent a TAVR experienced an excess cardiac and non-cardiac mortality compared to SAVR. More studies with long-term follow-up are needed to confirm the long-term clinical benefits of TAVR and effort to improve patient selection are warranted.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.003 | 0.007 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.001 | 0.002 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".