Bhardwaj Bhaskar, Kolte Dhaval, Zhao Yanglu, Alu Maria C, Zahr Firas, Passeri Jonathan J, Inglessis Ignacio, Vlahakes Gus J, Garcia Santiago, Cohen David J, Makkar Raj R, Kodali Susheel, Thourani Vinod H, Kapadia Samir, Palacios Igor F, Leon Martin B, Smith Craig R, Mack Michael J, Elmariah Sammy
Division of Cardiology, Knight Cardiovascular Institute, Oregon Health & Science University, Portland, Oregon.
Cardiology Division, Massachusetts General Hospital/Harvard Medical School, Boston, Massachusetts.
J Soc Cardiovasc Angiogr Interv. 2022 Nov 25;2(1):100531. doi: 10.1016/j.jscai.2022.100531. eCollection 2023 Jan-Feb.
Anemia is associated with increased mortality in patients undergoing transcatheter aortic valve replacement (TAVR); however, data on the effect of the severity of and recovery from anemia on clinical outcomes are limited. This study examined the impact of the severity of and recovery from anemia after TAVR.
Patients with symptomatic, severe aortic stenosis across all surgical risk groups from the Placement of Aortic Transcatheter Valves (PARTNER) I, II, and III trials and registries who underwent TAVR were analyzed. Baseline anemia was defined as mild (hemoglobin [Hb] level ≥11.0 g/dL and <13.0 g/dL for men and ≥11.0 g/dL and <12.0 g/dL for women) and moderate-to-severe anemia (Hb level <11.0 g/dL). Recovery from anemia was defined as an increase of ≥1 g/dL in the Hb level. Patients with missing Hb information and major bleeding within 30 days were excluded. The association of the severity of and recovery from anemia with clinical outcomes was analyzed using multivariable Cox proportional hazards regression models. The primary outcome was 1-year all-cause mortality.
The Kaplan-Meier estimate for 1-year all-cause mortality was 5.4%, 8.2%, and 14.5% in patients with no, mild, and moderate-to-severe anemia, respectively ( < .001). Recovery from anemia at 30 days occurred in 8.4% (229/2730) of all patients. Compared with those without baseline or 30-day anemia, patients with recovery from anemia had similar 1-year mortality (hazard ratio, 1.02; CI, 0.50-2.08; = .96), whereas those without recovery from anemia had higher 1-year mortality (hazard ratio, 1.82; CI, 1.17-2.85; = .009).
In patients undergoing TAVR, moderate-to-severe anemia is independently associated with increased 1-year mortality, and recovery from anemia after TAVR is associated with favorable outcomes. Further efforts are needed to determine whether preprocedural correction of anemia improves post-TAVR outcomes.
贫血与经导管主动脉瓣置换术（TAVR）患者的死亡率增加相关；然而，关于贫血严重程度及其恢复对临床结局影响的数据有限。本研究探讨了TAVR后贫血严重程度及其恢复的影响。
分析了来自主动脉经导管瓣膜置入（PARTNER）I、II和III试验及注册研究中所有手术风险组的有症状的严重主动脉瓣狭窄且接受TAVR的患者。基线贫血定义为轻度（男性血红蛋白[Hb]水平≥11.0 g/dL且<13.0 g/dL，女性≥11.0 g/dL且<12.0 g/dL）和中重度贫血（Hb水平<11.0 g/dL）。贫血恢复定义为Hb水平升高≥1 g/dL。排除Hb信息缺失和30天内发生大出血的患者。使用多变量Cox比例风险回归模型分析贫血严重程度及其恢复与临床结局的关联。主要结局是1年全因死亡率。
无贫血、轻度贫血和中重度贫血患者的1年全因死亡率的Kaplan-Meier估计值分别为5.4%、8.2%和14.5%（P<0.001）。所有患者中8.4%（229/2730）在30天时贫血恢复。与无基线或30天贫血的患者相比，贫血恢复的患者1年死亡率相似（风险比，1.02；95%CI，0.50-2.08；P = 0.96），而未恢复贫血的患者1年死亡率更高（风险比，1.82；95%CI，1.17-2.85；P = 0.009）。
在接受TAVR的患者中，中重度贫血与1年死亡率增加独立相关，TAVR后贫血恢复与良好结局相关。需要进一步努力确定术前纠正贫血是否能改善TAVR后的结局。
