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

• Published in: The American journal of cardiology 2014-11, Vol.114 (9), p.1447-1455
• Main Authors: Giordana, Francesca, MD, D'Ascenzo, Fabrizio, MD, Nijhoff, Freek, MD, Moretti, Claudio, MD, D'Amico, Maurizio, MD, Biondi Zoccai, Giuseppe, MD, Sinning, Jan Malte, MD, Nickenig, George, MD, Van Mieghem, Nicolas M., MD, Chieffo, Adelaide, MD, Dumonteil, Nicolas, MD, Tchetche, Didier, MD, Barbash, Israel M., MD, Waksman, Ron, MD, D'Onofrio, Augusto, MD, Lefevre, Thierry, MD, Pilgrim, Thomas, MD, Amabile, Nicolas, MD, Codner, Pablo, MD, Kornowski, Ran, MD, Yong, Ze Yie, MD, Baan, Jan, MD, Colombo, Antonio, MD, Latib, Azeem, MD, Salizzoni, Stefano, MD, Omedè, Pierluigi, MD, Conrotto, Federico, MD, La Torre, Michele, MD, Marra, Sebastiano, MD, Rinaldi, Mauro, MD, Gaita, Fiorenzo, MD
• Format: Article
• Language: English
• Subjects: Aortic Valve Stenosis - mortality; Aortic Valve Stenosis - surgery; Bias; Cardiovascular; Cardiovascular disease; Cause of Death; Chronic obstructive pulmonary disease; Confidence intervals; Drug therapy; Global Health; Humans; Hypotheses; Hypothesis testing; Medical prognosis; Mortality; Multivariate analysis; Postoperative Complications - mortality; Risk Assessment; Risk Factors; Statistical methods; Studies; Surgery; Thoracic surgery; Transcatheter Aortic Valve Replacement - mortality
• ISSN: 0002-9149; 1879-1913
• DOI: 10.1016/j.amjcard.2014.07.081

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