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

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Highlights

  • This review reports on the independent predictors of mortality after transcatheter aortic valve implantation.

  • High pro–brain natriuretic peptide levels and postprocedural acute kidney injury predict 30-day and 1-year mortality.

  • These findings may contribute to a better risk assessment of patients undergoing transcatheter aortic valve implantation.

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.

Section snippets

Methods

This study was conducted in accordance with the current guidelines, including the recent Preferred Reporting Items for Systematic reviews and Meta-Analyses amendment to the Quality of Reporting of Meta-analyses statement, and recommendations from The Cochrane Collaboration and Meta-analysis Of Observational Studies in Epidemiology (MOOSE).10

PubMed and Cochrane databases were searched for reports published in English from January 2002 to June 2013 according to the following highly sensitive

Results

The search strategy yielded 1,088 reports. Four reports derived from congresses were added, resulting in a total of 1,092 citations. All citations were first screened at title and abstract level; the 31 remaining reports were subsequently screened full text. Of the full-text analyzed citations, 4 were excluded because of reporting duplicate data11, 12, 13, 14 and 2 because of the absence of data on independent predictors for adverse events.15, 16 Twenty-five studies were finally included in

Discussion

Profound understanding of factors determining patient survival after TAVI is of paramount importance in clinical practice not only to enable to accurately select patients, that is, only those in whom treatment benefit outweighs the risk, but also to take appropriate measures to prevent complications in high-risk subjects, especially considering that the commonly used logistic EuroSCORE falls short in predicting mortality, as it does not take account of periprocedural events, and it is known to

Disclosures

The authors have no conflicts of interest to disclose.

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