At ACC.25, new data from the EARLY TAVR trial reinforced the need for early intervention in asymptomatic severe aortic stenosis (AS), showing that timely TAVR (transcatheter aortic valve replacement) offers significantly better outcomes and lower stroke rates compared to the traditional wait-and-see approach.
Key Findings:
- 40% of patients in the clinical surveillance arm faced rapid disease progression, resulting in cardiac arrest, heart failure, and stroke. These patients had a much higher risk of poor outcomes, including death.
- Early intervention with TAVR significantly reduced death, stroke, and unplanned hospitalizations, as shown in the latest data from ACC.25. The results support earlier treatment before severe symptoms arise.
Principal Investigator’s Insights:
Dr. Philippe Genereux, the study’s lead investigator, emphasized that 40% of patients who wait for symptoms to worsen experience a sudden and severe decline in health. These patients often develop acute valve syndrome, leading to life-threatening complications. Genereux argued that these findings highlight the need for a change in clinical guidelines to prioritize early TAVR over waiting.
Additional Findings:
- Predicting Rapid Decline: Identifying patients at risk for rapid progression remains challenging. Traditional echocardiography indicators failed to reliably predict which asymptomatic patients would deteriorate quickly.
- Aortic Stenosis and Stroke Risk: The data suggests that severe aortic stenosis may be an independent risk factor for stroke, with stroke rates nearly double in the delayed-intervention group compared to those who underwent early TAVR.
Call for Change:
Genereux stresses that the time has come to update industry guidelines. He advocates for a proactive approach, moving away from the “wait-and-see” strategy, and making early intervention a standard practice for asymptomatic severe AS patients.
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