Pronóstico de pacientes nonagenarios tras implante percutáneo de válvula aórtica

• Published in: REC, Interventional cardiology (Internet) Interventional cardiology (Internet), 2021-11, Vol.3 (4), p.250-257
• Main Authors: Albarrán, Agustín, Cepas Guillén, Pedro L, Andrak, Leire, Amat Santos, Ignacio, Ferrer García, María Cruz, Baz Alonso, José A, Mainar, Vicente, Lasa Larraya, Garikoitz, Nogales Asensio, Juan Manuel, Gil Albarova, Óscar, Moreu, José, García Blas, Sergio, Regueiro, Ander, Blanco Mata, Roberto, Freixa, Xavier, Ten Morro, Francisco, Fernández-Nofrerías, Eduard, Pinar Bermúdez, Eduardo, Sabaté Tenas, Manel, Melero Tejedor, José María, Ruiz-Salmerón, Rafael, Sanmiguel-Cervera, D, Romaguera Torres, Rafael, Cuellas Ramón, Carlos, Heredia Cambra, Tomás, Oteo Domínguez, Juan Francisco, Urbano Carrillo, Cristóbal A, Piñero Lozano, Antonio, Alfonso Manterola, Fernando
• Format: Article
• Language: eng ; spa
• Subjects: Ancianos; Aortic stenosis; Elderly; Estenosis aórtica; Nonagenarians; Nonagenarios; TAVI
• ISSN: 2604-7276; 2604-7306; 2604-7276
• DOI: 10.24875/RECIC.M21000216

Introduction and objectives: Nonagenarians are a fast-growing age group among cardiovascular patients, especially with aortic stenosis, but data about their prognosis after transcatheter aortic valve implantation (TAVI) is scarce. The objective of our study is to analyze the baseline characteristics of nonagenarians treated with TAVI and determine whether age "65; 90 years is associated with a worse prognosis compared to non-nonagenarian patients. Methods: We included all patients "65;75 years enrolled in the multicenter prospective Spanish TAVI registry between 2009 and 2018. Patients < 75 years were excluded. Results: A total of 8073 elderly patients ("65; 75 years) from 46 Spanish centers were enrolled in the Spanish TAVI registry; 7686 were between "65; 75 and < 90 years old (95.2%), and 387 were nonagenarian patients (4.79%). A gradual increase of nonagenarians was observed. The transfemoral access was used in 91.6% of the cases, predominantly among the nonagenarian patients (91.4% frente a 95.1%, P = .01). Nonagenarians were more likely to die during their hospital stay (4.3% frente a 7.0% among nonagenarians, P = .01). However, no difference was seen in the all-cause mortality rates reported at the 1-year follow-up (8.8% frente a 11.3%, P = .07). In the multivariate analysis, age "65; 90 years was not independently associated with a higher adjusted all-cause mortality rate (HR, 1.37, 95%CI, 0.91- 1.97, P = .14). The baseline creatinine levels, and the in-hospital bleeding complications were all associated with a worse long-term prognosis in nonagenarians treated with TAVI. Conclusions: Nonagenarians are a very high-risk and growing population with severe AS in whom TAVI may be a safe and effective team is mandatory to achieve maximum efficiency in this population where baseline kidney function and bleeding complications may determine the long-term prognosis after TAVI. Introducción y objetivos: Los nonagenarios son un grupo de edad en rápido crecimiento entre los pacientes cardiovasculares, en especial con estenosis aórtica, pero los datos sobre su pronóstico después de la implantación transcatéter de válvula aórtica (TAVI) son escasos. El objetivo de este estudio es analizar las características basales de los nonagenarios tratados con TAVI y determinar si la edad "65; 90 años está relacionada con un peor pronóstico en comparación con los pacientes no nonagenarios. Métodos: Se incluyó a todos los pacientes "65; 75 años inscritos en el registro prosp