Early TAVR Intervention Reduces Cardiovascular Events in Asymptomatic Aortic Stenosis Patients

Two common treatments for AS include transcatheter aortic valve replacement (TAVR), a minimally invasive procedure that replaces the diseased valve with a new one, and clinical surveillance (CS), which involves regular patient monitoring. Now, late-breaking results from the EARLY TAVR trial presented at the SCAI 2025 Scientific Sessions have revealed that patients between the ages of 65 and 70 benefited the most from early intervention with TAVR, particularly in terms of stroke risk and in the composite outcomes of death, stroke, and heart failure hospitalization.

For individuals with asymptomatic, severe AS, the EARLY TAVR trial led by Atlantic Health System (Morristown, NJ, USA) demonstrated that early TAVR was more effective than CS in improving the primary endpoint, which included death, stroke, and unplanned cardiovascular hospitalizations. This presentation marked the first report from the randomized, controlled EARLY TAVR trial regarding whether a patient’s age should influence the timing of procedures for those with asymptomatic, severe AS. The study primarily aimed to assess the rates of death, stroke, and unplanned cardiovascular hospitalizations. A total of 901 patients with asymptomatic severe AS were enrolled, with 455 patients assigned to the early TAVR group and 446 to the CS group. The average follow-up period was 3.8 years, and baseline characteristics and health status were similar between the two groups.

Older age was found to be associated with higher rates of death, stroke, or heart failure (HF) hospitalizations up to five years post-procedure in both groups. Early TAVR showed benefits over CS across all age groups. However, patients aged 65-69 who underwent early TAVR experienced the most significant benefits, including a notable reduction in stroke risk (0% for early TAVR vs. 13% for CS), and a six-fold lower rate of death, stroke, or HF hospitalization compared to those who received CS (4.7% vs. 25.6%, respectively) over the five-year follow-up period. Patients over 80 years old also experienced substantial benefits, particularly in stroke risk, with the early TAVR strategy associated with a four-fold reduction in stroke compared to CS during the same five-year period.

"Those results are important and highlights the benefits of early intervention among younger patients with asymptomatic severe aortic stenosis, especially in regards to stroke risk, a complication which is the most feared by patients,” said Philippe Genereux, MD, lead author of the study. “We are discovering that aortic stenosis itself might be an important risk factor of stroke if left untreated. Taking all together, and given the benefits and the lack of risks in patients 65 years or greater, early TAVR should be preferred to clinical surveillance in all age groups​.”

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