PROGRESS
in moderate aortic stenosis with at-risk features, upfront TAVR gives fewer deaths or heart-failure events at two years than clinical surveillance (16.7 versus 23.9 percent), but the gain lies entirely in heart failure and not in mortality
Presented again in FS.13 at AHA 2026 (Monday 9 November) after its TCT 2026 debut and NEJM publication of 2 November. PROGRESS randomised 744 patients (mean age 78, 39.1 percent women, 45.6 percent low surgical risk, mean valve area 1.2 cm2, peak velocity 3.3 m/s) with moderate aortic stenosis and at least one at-risk feature to transfemoral TAVR with a balloon-expandable valve (373) or clinical surveillance (371). The primary endpoint of death from any cause or a heart-failure event at 2 years occurred in 16.7 versus 23.9 percent (risk difference minus 7.2 percentage points, 95 percent CI minus 13.1 to minus 1.3, P=0.02 for superiority); death 8.4 versus 7.3 percent, heart-failure events 10.8 versus 19.0 percent; procedure-related adverse events did not differ meaningfully. The Edwards release adds heart-failure hospitalisation 7.4 versus 14.9 percent, KCCQ plus 15.5 points at 30 days and delayed valve replacement in 27 percent at one year and 57 percent at two years in the surveillance arm. Jeroen Bax (LUMC) and Nicolas Van Mieghem (Erasmus MC) are co-authors. The benefit is driven by heart failure in an open-label design; mortality is unchanged; the indication is moderate stenosis with at-risk features, not moderate stenosis as such.
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