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Meta-Analysis of Predictors of All-Cause Mortality After Transcatheter Aortic Valve Implantation

2014; Elsevier BV; Volume: 114; Issue: 9 Linguagem: Inglês

10.1016/j.amjcard.2014.07.081

1879-1913

Francesca Giordana, Fabrizio D’Ascenzo, Freek Nijhoff, Claudio Moretti, Maurizio D’Amico, Giuseppe Biondi‐Zoccai, Jan Malte Sinning, G Nickenig, Nicolas M. Van Mieghem, Alaide Chieffo, Nicolas Dumonteil, Didier Tchetché, Israel M. Barbash, Ron Waksman, Augusto D’Onofrio, Thierry Lefévre, Thomas Pilgrim, Nicolas Amabile, Pablo Codner, Ran Kornowski, Ze Yie Yong, Jan Baan, Antonio Colombo, Azeem Latib, Stefano Salizzoni, Pierluigi Omedè, Federico De Marco, Michele La Torre, Sebastiano Marra, Mauro Rinaldi, Fiorenzo Gaïta,

Atrial Fibrillation Management and Outcomes

The aim of this study was to identify predictors of 30-day and midterm mortality after transcatheter aortic valve implantation (TAVI) by means of a systemic review. TAVI was demonstrated to be safe and efficacious in patients with severe aortic stenosis. An accurate estimation of procedural risk of these patients represents an actual challenge. The PubMed and Cochrane Collaboration databases were systematically searched for studies reporting on the incidence and independent predictors of 30-day and midterm mortality. Adverse events were pooled with random effect, whereas independent predictors are reported as odds ratios (ORs) with 95% confidence intervals (CIs). A total of 25 studies with 8,874 patients were included (median age 82.5 ± 1.5 years, 54.6% women). At 30 days, 7.5% of patients (n = 663) died. At midterm follow-up (median 365 days, interquartile range 267 to 365 days), the cumulative mortality rate was 21.6% (n = 1,917). Acute kidney injury (AKI) stage ≥2 (OR 18.0, 95% CI 6.3 to 52), preprocedural hospitalization for heart failure (OR 9.4, 95% CI 2.6 to 35), periprocedural acute myocardial infarction (OR 8.5, 95% CI 2.6 to 33.5), and increased pro-brain natriuretic peptide (pro-BNP) levels (OR 5.4, 95% CI 1.7 to 16.5) were the most important independent predictors of 30-day mortality. Increased pro-BNP levels (OR 11, 95% CI 1.5 to 81), AKI stage 3 (OR 6.8, 95% CI 2.6 to 15.7), left ventricular ejection fraction <30% (OR 6.7, 95% CI 3.5 to 12.7), and periprocedural acute myocardial infarction (OR 6.5, 95% CI 2.3 to 18.1) represented the predictors of midterm mortality. In conclusion, in this large meta-analysis of patients undergoing TAVI, we found that high pro-BNP levels and postprocedural AKI were the strongest independent predictors of both 30-day and 1-year mortality. These findings may contribute to a better understanding of the risk assessment process of patients undergoing TAVI.