Masri Ahmad, Chen Yong, Colavecchia A Carmine, Benjumea Darrin, Crowley Aaron, Jhingran Priti, Kent Matthew, Wogen Jenifer, Pankratova Cindi, Jimenez Alvir Jose Maria, Bhambri Rahul
Division of Cardiovascular Medicine Knight Cardiovascular Institute, Oregon Health & Science University Portland OR USA.
Pfizer Inc New York NY USA.
J Am Heart Assoc. 2025 Jan 21;14(2):e033251. doi: 10.1161/JAHA.123.033251. Epub 2025 Jan 16.
The coexistence of transthyretin cardiac amyloidosis (ATTR-CA) and aortic stenosis (AS) is increasingly recognized, but the clinical consequences are unclear. We aimed to characterize clinical outcomes in AS plus ATTR-CA compared with only AS or ATTR-CA.
In a retrospective cohort study, patients with AS only, ATTR-CA only, or AS plus ATTR-CA were identified using all-payer claims data (2015-2021). Eligible patients had ≥1 claim for AS or cardiac amyloidosis (excluding light-chain cardiac amyloidosis); were aged ≥60 years; and were continuously enrolled in medical plans for ≥6 months after diagnosis. Ad hoc subanalyses were conducted in patients with aortic valve replacement at first diagnosis (surrogate for severe AS). Of 355 430 eligible patients, 345 771 (97.3%), 8453 (2.4%), and 1239 (0.3%) were included in the AS-only, ATTR-CA-only, and AS-plus-ATTR-CA cohorts, respectively; 41 312 (11.9%), 14 (0.2%), and 212 (17.1%) had aortic valve replacement. Two-year mortality rates were 16.1% (95% CI, 15.9-16.2), 14.8% (95% CI, 13.9-15.7), and 19.2% (95% CI, 16.9-21.8) in the AS-only, ATTR-CA-only, and AS-plus-ATTR-CA cohorts; heart failure hospitalization rates were 29.4% (95% CI, 29.2-29.5), 22.8% (95% CI, 21.9-23.8), and 48.7% (95% CI, 45.7-51.7). AS plus ATTR-CA was associated with increased risk of death (HR, 1.3 [95% CI, 1.1-1.4]; <0.0001) and heart-failure hospitalization (HR, 1.9 [95% CI, 1.8-2.1]; <0.0001) versus AS alone. In the aortic valve replacement subgroup, AS plus ATTR-CA was associated with an increased mortality rate (HR, 1.4 [95% CI, 1.1-1.8]; =0.003) but not heart failure hospitalization (HR, 1.1 [95% CI, 0.9-1.3]; =0.07) versus AS only.
Patients with AS plus ATTR-CA experience worse clinical outcomes than patients with AS only. Increased awareness of these coexisting conditions may help facilitate earlier screening and improve prognosis.
转甲状腺素蛋白心脏淀粉样变性（ATTR-CA）与主动脉瓣狭窄（AS）并存的情况越来越受到关注，但其临床后果尚不清楚。我们旨在描述AS合并ATTR-CA与单纯AS或ATTR-CA相比的临床结局。
在一项回顾性队列研究中，利用所有支付方的索赔数据（2015 - 2021年）识别出单纯AS、单纯ATTR-CA或AS合并ATTR-CA的患者。符合条件的患者有≥1次AS或心脏淀粉样变性（不包括轻链心脏淀粉样变性）的索赔记录；年龄≥60岁；诊断后连续参加医疗计划≥6个月。对首次诊断时进行主动脉瓣置换的患者（严重AS的替代指标）进行了专项亚组分析。在355430名符合条件的患者中，分别有345771名（97.3%）、8453名（2.4%）和1239名（0.3%）被纳入单纯AS、单纯ATTR-CA和AS合并ATTR-CA队列；41312名（11.9%）、14名（0.2%）和212名（17.1%）进行了主动脉瓣置换。单纯AS、单纯ATTR-CA和AS合并ATTR-CA队列的两年死亡率分别为16.1%（95%CI，15.9 - 16.2）、14.8%（95%CI，13.9 - 15.7）和19.2%（95%CI，16.9 - 21.8）；心力衰竭住院率分别为29.4%（95%CI，29.2 - 29.5）、22.8%（95%CI，21.9 - 23.8）和48.7%（95%CI，45.7 - 51.7）。与单纯AS相比，AS合并ATTR-CA与死亡风险增加（HR，1.3[95%CI，1.1 - 1.4]；<0.0001）和心力衰竭住院风险增加（HR，1.9[95%CI，1.
