Marco Zimarino1,2, Marco Barbanti3, George D Dangas4, Luca Testa5, Davide Capodanno3, Giulio G Stefanini6,7, Francesco Radico1, Michele Marchioni8, Ignacio Amat-Santos9, Tommaso Piva10, Francesco Saia11, Bernhard Reimers6,7, Carlo De Innocentiis, Andrea Picchi3, Alessandro Toro1, Tania Rodriguez-Gabella9, Elisa Nicolini10, Carolina Moretti11, Sabina Gallina1, Nicola Maddestra2, Francesco Bedogni5, Corrado Tamburino3. 1. Institute of Cardiology (M.Z., F.R., A.T., S.G.), "G. d'Annunzio" University Chieti-Pescara, Italy. 2. Interventional Cath Lab, ASL 2 Abruzzo, Chieti, Italy (M.Z., N.M.). 3. Division of Cardiology, Ferrarotto Hospital, University of Catania, Italy (M.B., D.C., A.P., C.T.). 4. The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York (G.D.D.). 5. Department of Cardiology, IRCCS Pol. S. Donato, S. Donato Milanese Milan, Italy (L.T., F.B.). 6. Department of Biomedical Sciences, Humanitas University, Pieve Emanuele-Milan, Italy (G.G.S., B.R.). 7. Humanitas Clinical and Research Center IRCCS, Rozzano-Milan, Italy (G.G.S., B.R.). 8. Department of Medical, Oral and Biotechnological Sciences, Laboratory of Biostatistics (M.M.), "G. d'Annunzio" University Chieti-Pescara, Italy. 9. CIBERCV, Hospital Clínico Universitario de Valladolid, Spain (I.A.-S., T.R.-G.). 10. Interventional Cardiology, Ospedali Riuniti di Ancona, Ancona, Italy (T.P., E.N.). 11. Division of Cardiology, Cardiothoracic and Vascular Department, S. Orsola Hospital, Bologna University, Bologna, Italy (F.S., C.M.).
Abstract
BACKGROUND: There is no consensus on the benefit of red blood cell (RBC) transfusion after transcatheter aortic valve replacement. METHODS: The multicenter Transfusion Requirements in Transcatheter Aortic Valve Implantation (TRITAVI) registry retrospectively included patients after transfemoral transcatheter aortic valve replacement; propensity score-matching identified pairs of patients with and without RBC transfusion. The primary end point was 30-day mortality; nonfatal myocardial infarction, cerebrovascular accident, and stage 2 to 3 acute kidney injury at 30 days were secondary end points. We repeated propensity score-matching according to the hemoglobin nadir, hemoglobin drop, and in the subgroup of uncomplicated patients, without major vascular complications or major bleeding. RESULTS: Among 2587 patients, RBC transfusion was administered in 421 cases (16%). The primary end point occurred in 104 (4.0%) patients, myocardial infarction in 9 (0.4%), cerebrovascular accident in 38 (1.5%), and acute kidney injury in 125 (4.8%) cases. In the 842 propensity-matched patients, RBC transfusion was associated with increased mortality (hazard ratio, 2.07 [95% CI, 1.06-4.05]; P=0.034) and acute kidney injury (hazard ratio, 4.35 [95% CI, 2.21-8.55]; P<0.001). Interaction testing between RBC transfusion and mortality was not statistically significant in the above-mentioned subgroups, and such association was not documented in the corresponding propensity score-matched cohorts. In the multivariable Cox proportional hazards regression model, major vascular complications (P=0.044), major bleeding (P=0.041), and RBC transfusion (P=0.048) were independent correlates of 30-day mortality. CONCLUSIONS: RBC transfusion correlates with increased mortality and acute kidney injury early after transcatheter aortic valve replacement and is an independent predictor of 30-day mortality, irrespective of periprocedural major bleeding and vascular complications. Registration: URL: https://www.clinicaltrials.gov. Unique identifier: NCT03740425.
BACKGROUND: There is no consensus on the benefit of red blood cell (RBC) transfusion after transcatheter aortic valve replacement. METHODS: The multicenter Transfusion Requirements in Transcatheter Aortic Valve Implantation (TRITAVI) registry retrospectively included patients after transfemoral transcatheter aortic valve replacement; propensity score-matching identified pairs of patients with and without RBC transfusion. The primary end point was 30-day mortality; nonfatal myocardial infarction, cerebrovascular accident, and stage 2 to 3 acute kidney injury at 30 days were secondary end points. We repeated propensity score-matching according to the hemoglobin nadir, hemoglobin drop, and in the subgroup of uncomplicated patients, without major vascular complications or major bleeding. RESULTS: Among 2587 patients, RBC transfusion was administered in 421 cases (16%). The primary end point occurred in 104 (4.0%) patients, myocardial infarction in 9 (0.4%), cerebrovascular accident in 38 (1.5%), and acute kidney injury in 125 (4.8%) cases. In the 842 propensity-matched patients, RBC transfusion was associated with increased mortality (hazard ratio, 2.07 [95% CI, 1.06-4.05]; P=0.034) and acute kidney injury (hazard ratio, 4.35 [95% CI, 2.21-8.55]; P<0.001). Interaction testing between RBC transfusion and mortality was not statistically significant in the above-mentioned subgroups, and such association was not documented in the corresponding propensity score-matched cohorts. In the multivariable Cox proportional hazards regression model, major vascular complications (P=0.044), major bleeding (P=0.041), and RBC transfusion (P=0.048) were independent correlates of 30-day mortality. CONCLUSIONS: RBC transfusion correlates with increased mortality and acute kidney injury early after transcatheter aortic valve replacement and is an independent predictor of 30-day mortality, irrespective of periprocedural major bleeding and vascular complications. Registration: URL: https://www.clinicaltrials.gov. Unique identifier: NCT03740425.
Authors: Mohammed Y Khanji; Fabrizio Ricci; Victor Galusko; Baskar Sekar; C Anwar A Chahal; Laura Ceriello; Sabina Gallina; Simon Kennon; Wael I Awad; Adrian Ionescu Journal: Eur Heart J Qual Care Clin Outcomes Date: 2021-07-21
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Authors: Helge Möllmann; David M Holzhey; Michael Hilker; Stefan Toggweiler; Ulrich Schäfer; Hendrik Treede; Michael Joner; Lars Søndergaard; Thomas Christen; Dominic J Allocco; Won-Keun Kim Journal: Clin Res Cardiol Date: 2021-06-20 Impact factor: 5.460