Influence of marital status in patients undergoing transcatheter aortic valve implantation

Background: Marital status has been described to affect outcome in cardiovascular diseases, however its impact on patients undergoing transcatheter aortic valve implantation (TAVI) is unknown. We therefore aimed to assess the impact of marital status in patients undergoing TAVI. Methods: Between 2011 and 2015, 779 patients undergoing transfemoral TAVI with known marital status were included in the analysis. The primary endpoint of the study was the composite of cardiac death and readmission for congestive heart failure (CHF) at one year. Results: Mean age was 80.7±5.9 years, 47.8% were female and median logistic EuroScore was 12.7% (8.13-19.39%). Forty-three point three percent of patients were not married. Compared to married patients, unmarried patients were older (82.4±5.5 vs. 79.5±5.8 years; P<0.001), more often female (73.3% vs. 28.3%; P<0.001), presented with a higher logistic EuroScore [13.1% (9.5-21.5%) vs. 11.7% (7.0-18.5%); P<0.001], and more symptomatic with New York Heart Association functional class III/IV (69.7% vs. 60.6%; P=0.009). At one year the incidence of the primary endpoint was higher in unmarried patients (18.7% vs. 12.0%; P=0.011) which was mainly driven by more admissions for CHF (14.1% vs. 7.8%; P=0.007). After multivariable adjustment, marital status was borderline significant regarding CHF (HR 0.61, 95% CI: 0.37-1.02; P=0.06) but not the primary endpoint. Conclusions: Unmarried patients undergoing TAVI showed a higher incidence of cardiac death or CHF at one year. Hence, marital status should be taken into account in patients with aortic stenosis subjected to TAVI. Whether closer monitoring and intensified medical follow-up improves outcomes remains to be investigated in future studies.