The Zena and Michael A.Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York.
Department of Cardiology, Istituto Clinico Humanitas, Milan, Italy.
Catheter Cardiovasc Interv. 2021 Apr 1;97(5):E704-E715. doi: 10.1002/ccd.29276. Epub 2020 Oct 1.
To assess the impact of anemia on clinical outcomes in female patients enrolled in the Women's InterNational transcatheter aortic valve implantation (WIN-TAVI) registry.
Anemia is highly prevalent among females who constitute half of TAVI candidates, yet, its clinical significance remains poorly investigated.
Patients were divided into three groups according to preprocedural hemoglobin (Hb) level: (1) no anemia (Hb ≥12 g/dl), (2) mild-to-moderate anemia (10 ≤ Hb <12 g/dl), and (3) severe anemia (Hb <10 g/dl). The primary outcome was the occurrence of Valve Academic Research Consortium (VARC)-2 efficacy endpoint, a composite of mortality, stroke, myocardial infarction (MI), hospitalization for valve-related symptoms or heart failure or valve-related dysfunction at 1-year follow-up.
Hemoglobin level was available in 877 (86.1%) patients: 412 (47.0%) had no anemia, 363 (41.4%) had mild-to-moderate anemia, and 102 (11.6%) had severe anemia. The latter group had a higher prevalence of cardiovascular risk factors. Compared with patients without anemia, severe anemia was associated with a greater risk of VARC-2 efficacy endpoint ( HR 1.71, 95% CI: 1.02-2.87, p = .04), all-cause death ( HR 2.36, 95% CI: 1.31-4.26, p = .004) and a composite of death, MI or stroke ( HR 1.88, 95% CI: 1.10-3.22, p = .02) at 1 year. Moreover, an increased risk of late mortality ( HR 1.15, 95% CI: 1.02-1.30, p = .03) was observed with every 1 g/dl decrease in hemoglobin level.
Severe anemia in females undergoing TAVI was independently associated with increased rates of VARC-2 efficacy endpoint and mortality at 1 year.
评估女性患者在 Women's InterNational transcatheter aortic valve implantation (WIN-TAVI) 注册研究中的贫血对临床结局的影响。
贫血在构成 TAVI 候选人群一半的女性中非常普遍，但贫血的临床意义仍未得到充分研究。
根据术前血红蛋白（Hb）水平将患者分为三组：（1）无贫血（Hb≥12 g/dl）；（2）轻度至中度贫血（10≤Hb<12 g/dl）；（3）重度贫血（Hb<10 g/dl）。主要结局为 Valve Academic Research Consortium (VARC)-2 疗效终点的发生，该终点是死亡、卒中和心肌梗死（MI）、因瓣膜相关症状或心力衰竭或瓣膜相关功能障碍而住院的复合终点，随访 1 年。
877 例（86.1%）患者的血红蛋白水平可获得：412 例（47.0%）无贫血，363 例（41.4%）为轻度至中度贫血，102 例（11.6%）为重度贫血。后者组心血管危险因素的发生率更高。与无贫血患者相比，重度贫血与 VARC-2 疗效终点（HR 1.71，95%CI：1.02-2.87，p=0.04）、全因死亡（HR 2.36，95%CI：1.31-4.26，p=0.004）和死亡、MI 或卒中的复合终点（HR 1.88，95%CI：1.10-3.22，p=0.02）的风险增加相关。此外，血红蛋白水平每降低 1 g/dl，观察到晚期死亡率的风险增加（HR 1.15，95%CI：1.02-1.30，p=0.03）。
女性行经导管主动脉瓣置换术（TAVI）时发生重度贫血与 1 年时 VARC-2 疗效终点和死亡率的增加独立相关。
