TAVR in Patients with Moderate Aortic Stenosis with At-Risk Features.

In an international randomized trial of 744 patients with moderate aortic stenosis and at-risk features, TAVR reduced the 2-year primary endpoint to 16.7% versus 23.9%.

• Why it matters: Guidelines recommend echocardiographic surveillance for moderate aortic stenosis, but it was unknown whether earlier intervention with TAVR improves outcomes in higher-risk patients.
• What they did: Patients were assigned 1:1 to transfemoral TAVR with a balloon-expandable valve or clinical surveillance, with a primary endpoint of death or a heart-failure event at 2 years.
• The result: Superiority was supported by a risk difference of -7.2 percentage points (95% CI, -13.1 to -1.3; P=0.02), with heart-failure events of 10.8% vs 19.0%.

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