# Survival in patients with monoclonal gammopathy of unknown significance after transcatheter aortic valve replacement: a global retrospective propensity-matched real-world analysis

## TL;DR

This study finds that patients with monoclonal gammopathy of unknown significance (MGUS) have worse long-term survival after heart valve replacement, especially those over 75 years old.

## Contribution

The first real-world analysis showing MGUS is linked to worse survival after TAVI, particularly in older patients.

## Key findings

- MGUS patients over 75 years had worse 5-year survival after TAVI compared to non-MGUS patients.
- MGUS patients under 75 or with common comorbidities had similar survival rates to non-MGUS patients.
- The study suggests MGUS may be a risk factor for poor outcomes after TAVI.

## Abstract

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.

Investigate overall survival in MGUS patients after TAVI.

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.

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).

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.