Abstract
BACKGROUND: Hematopoietic clonal disorders have previously been associated with cardiac diseases. Higher incidences of aortic valve stenosis have been observed not only in clonal hematopoiesis of indeterminate potential (CHIP) but also in monoclonal gammopathy of unknown significance (MGUS). However, studies investigating the outcome after transcatheter aortic valve implantation (TAVI) in MGUS are lacking. OBJECTIVE: Investigate overall survival in MGUS patients after TAVI. METHODS: We used the federated real-world data platform TriNetX to identify MGUS patients undergoing TAVI. Patients were divided into cohorts based on presence of MGUS, age or comorbidities and matched using the TriNetX propensity score matching tool. Overall survival was assessed after 1, 3 and 5 years. RESULTS: We identified 58,796 patients with TAVI procedure. Of these, 1039 patients (1.8%) were identified with co-occurring MGUS. Our study shows superior overall survival for patients without MGUS after TAVI in the overall cohort (HR:0.792 CI95% 0.657, 0.954, p = 0.014) and > 75 years of age (HR:0.797, CI95% 0.660, 0.961, p = 0.017) at the 5-year timepoint. 5-year overall survival did not differ in younger MGUS patients (< 75 years) or patients with co-occurring chronic kidney disease, chronic obstructive pulmonary disease or heart failure (p > 0.05). CONCLUSION: In this real-world analysis in patients with MGUS undergoing TAVI, MGUS was associated with inferior outcomes after TAVI, especially for older (> 75 years) patients. Five-year overall survival did not differ among patients with common comorbidities. Our results suggest that MGUS may be linked to worse overall long-term survival following TAVI and highlights the need for further interdisciplinary cardiooncology research. Given the key methodological limitations, the present results should be considered as hypothesis-generating.