Smoker's paradox in transcatheter aortic valve replacement: A National Inpatient Sample analysis from 2015 to 2020

While smoking is recognized as a risk factor for multiple cardiovascular conditions, prior research has identified a smoker paradox, wherein smokers had better post-procedural outcomes following transcatheter aortic valve replacement (TAVR) in the initial years of its introduction among high-risk pa...

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Bibliographic Details
Published in:Cardiovascular revascularization medicine 2024-05, Vol.62, p.21-26
Main Authors: Li, Renxi, Luo, Qianyun, Yanavitski, Marat, Huddleston, Stephen J
Format: Article
Language:English
Subjects:
Aged
Aged, 80 and over
Aortic Valve - diagnostic imaging
Aortic Valve - surgery
Aortic Valve Stenosis - diagnostic imaging
Aortic Valve Stenosis - mortality
Aortic Valve Stenosis - surgery
Databases, Factual
Female
Hospital Mortality
Humans
Inpatients
Male
Non-Smokers
Postoperative Complications - mortality
Protective Factors
Retrospective Studies
Risk Assessment
Risk Factors
Smokers
Smoking - adverse effects
Smoking - epidemiology
Time Factors
Transcatheter Aortic Valve Replacement - adverse effects
Transcatheter Aortic Valve Replacement - mortality
Treatment Outcome
United States - epidemiology
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Summary:While smoking is recognized as a risk factor for multiple cardiovascular conditions, prior research has identified a smoker paradox, wherein smokers had better post-procedural outcomes following transcatheter aortic valve replacement (TAVR) in the initial years of its introduction among high-risk patients only. In recent years, TAVR has expanded to significant larger groups of low-risk patients and became the dominate approach for aortic valve replacement. Consequently, the study cohort from the previous research can no longer represent the current patient populations undergoing TAVR. This study aimed to examine the impact of smoking on TAVR outcomes in the later post-TAVR era. Patients who underwent TAVR were identified in the National Inpatient Sample (NIS) database from the last quarter of 2015-2020 by ICD-10-PCS. Patients were stratified into two cohorts based on smoker status. Multivariable analysis was performed comparing in-hospital post-TAVR outcomes. Adjusted pre-procedural variables included sex, age, race, socioeconomic status, comorbidities, and hospital characteristics. A total number of 58,934 patients who underwent TAVR were identified including 23,683 smokers and 35,251 non-smokers. Compared to non-smokers, smokers had lower in-hospital mortality (aOR 0.589, p 
ISSN:1553-8389
1878-0938
DOI:10.1016/j.carrev.2023.11.021