11 The influence of ethnicity on clinical outcomes following transcatheter aortic valve implantation (TAVI)
Bibliographic record
Abstract
Background We have previously shown that minority ethnic groups are proportionately represented in the cohort of patients undergoing TAVI at our centre. This was an encouraging finding, however, the relationship between ethnicity and clinical outcomes following TAVI in our local population is unknown. Concerningly, this finding is reflected in a wider lack of published work on this important topic. Aim To analyse the influence of ethnicity on outcomes following TAVI in a continuous cohort of patients treated at a tertiary referral centre in the UK over the last 10 years. Methods A retrospective analysis of 1049 patients (9.7% non-white) undergoing TAVI from 2013 to 2023 was conducted. Data was submitted to National Institute for Cardiovascular Outcomes Research (NICOR) TAVI database. Primary outcomes included death and composite 3-point major adverse cardiac events (MACE) (death, from any cause, non-fatal myocardial infarction, and stroke) before discharge during TAVI admission. Post-TAVI survival time was also assessed. Given the relatively low number of events, a composite group of non-white patients was created. Variables were compared using Chi-squared or student’s t-test. Cox regression analysis was performed for independent predictors of survival. Procedural outcomes were adjusted using multivariate regression. Results In our cohort of 1049 TAVI patients, 90.3% were white, 2.4% black, 5.5% Asian, 0.2% Chinese and 1.5% other/unknown. At baseline, non-white patients in our cohort were 3 years younger, (83.0 ± 7.0 vs 80.0 ± 7.8, p < 0.01) but more likely to have diabetes (25.4% vs 48%, p < 0.01), New York Heart Association (NYHA) class IV Heart Failure (30.4% vs 41.2%, p = 0.03) and experience Canadian Cardiovascular Society (CCS) class IV angina (1.2% vs 4.9%, p = 0.01). Non-white patients were more likely to undergo non-elective TAVI (15.0% vs 27.5%, p < 0.01) and received smaller valves (28.22 mm ±2.855 vs 26.61 mm ±2.754, p <.001). Rates of death (2.5% vs 2.0%, p = 1) and 3-point MACE from TAVI to discharge (5.0% vs 6.9%, p = 0.4) did not differ significantly between groups. Post TAVI median survival between did not significantly differ (1538 days vs 1626 days, p = 0.8). Cox-regression showed ethnicity is not an independent predictor of survival (p=0.256) Categorical data presented as (white % vs non-white %). Continuous as (white ± standard deviation vs non-white ± standard deviation). Odds ratios adjusted. Conclusion Short term outcomes and median survival following TAVI do not significantly differ between white and non-white patients in our centre. However, non-white patients were found to have worse symptoms of heart failure and angina at baseline. Non-white patients were also more likely to undergo non-elective TAVI. This raises the possibility of delayed recognition or referral of aortic stenosis in non-white patients. Further, dedicated work is warranted to explore the reproducibility of this finding in larger, multi-centre cohorts. Conflict of Interest Nil
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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 | 0.001 | 0.004 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.003 | 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".