Association of Smoking Status With Long‐Term Mortality and Health Status After Transcatheter Aortic Valve Replacement: Insights From the Society of Thoracic Surgeons/American College of Cardiology Transcatheter Valve Therapy Registry

Background Smoking is a significant risk factor for aortic stenosis but its impact on clinical and health status outcomes after transcatheter aortic valve replacement (TAVR) has not been described. Methods and Results Patients (n=72 165) undergoing TAVR at 457 US sites in the STS/ACC TVT (Society of Thoracic Surgeons/American College of Cardiology Transcatheter Valve Therapy) Registry between November 2011 and June 2016 were categorized at the time of TAVR as current/recent smokers versus prior/nonsmokers. A series of multivariable models examined the association between smoking status and outcomes, including 1‐year mortality, rehospitalization, mean gradient, and health status (measured by the 12‐item Kansas City Cardiomyopathy Questionnaire–Overall Summary Score [KCCQ‐OS]) and in‐hospital outcomes. A total of 4063 patients (5.6%) were smokers. Smokers presented for TAVR at a younger age (75 [68–81] years versus 83 [77–88] years) but with a greater burden of cardiovascular and lung disease. In adjusted models, smoking was associated with lower in‐hospital mortality (relative risk, 0.74; 95% CI, 0.62–0.89 [P=0.001]) but not with in‐hospital stroke/transient ischemic attack or myocardial infarction. Smoking status had no association with postdischarge mortality, stroke, myocardial infarction, or heart failure (HF) but was associated with slightly lower 1‐year KCCQ‐OS scores (2.4‐point lower KCCQ‐OS; 95% CI, −4.6 to −0.2 [P=0.031]) and higher mean aortic valve gradients (11.1 versus 10.2 mm Hg, P<0.001) in adjusted models. Conclusions The current/recent smoking rate in US patients with TAVR is 5.6% and smokers present at a younger age for TAVR. Smoking was associated with lower in‐hospital but similar long‐term survival after TAVR, slightly worse long‐term health status, and marginally higher mean aortic valve gradients. Further research is needed to understand the effect of smoking cessation on outcomes.