Predictors of In-Hospital Mortality in Patients With End-Stage Renal Disease Undergoing Transcatheter Aortic Valve Replacement: A Nationwide Inpatient Sample Database Analysis

Ullah, Waqas; Jafar, Munnam; Zahid, Salman; Ahmed, Faizan; Khan, Muhammad Zia; Sattar, Yasar; Fischman, David L.; Virani, Salim S.; Alam, Mahboob

doi:10.1016/j.carrev.2021.02.002

Cited by 14 publications

(9 citation statements)

References 14 publications

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“…The phenomenon of the obesity paradox has been seen in our study, which was previously described for diseases such as myocardial infarction, heart failure, and renal disease [30]. Similarly, prior TAVR literature data based on NIS reported hypertension as a protective factor against mortality [18].…”

Section: Discussionsupporting

confidence: 82%

“…According to a previous study, major bleeding is associated with a three-fold increase in one-year mortality following TAVR and SAVR [18]. A previous study reported that major bleeding and life-threatening bleeding after TAVR, as defined by the Valve Academic Research Consortium (VARC) criteria, occurred in approximately 15-20% of TAVR procedures [13].…”

Section: Discussionmentioning

confidence: 99%

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An Analysis of the Predictors of Major Bleeding After Transcatheter Aortic Valve Transplantation Using the National Inpatient Sample (2015–2018)

Khan¹,

Gilani²,

Qayum³

et al. 2021

Cureus

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BackgroundTranscatheter aortic valve replacement (TAVR) is now a common procedure to treat and improve quality of life, clinical outcomes, and self-sufficiency in high-risk patients with aortic stenosis, and its use has been expanding rapidly in younger and low-risk populations. The aim of this study was to evaluate the outcomes, trends, and predictors of major bleeding in patients undergoing TAVR. MethodologyWe utilized the National Inpatient Sample (NIS) data from the year 2015 to 2018. International Classification of Disease 10 codes were utilized to extract data. Baseline characteristics were compared using Pearson's chisquare test for categorical variables and independent samples t-test for continuous variables. A multivariable logistic regression model was used to evaluate the predictors of major bleeding. Propensity matching was done for adjusted analysis to compare outcomes in TAVR with and without major bleeding. The outcomes of interest in this study were (1) predictors of major bleeding after TAVR; (2) in-hospital mortality; and (3) resource utilization in terms of cost and length of stay. ResultsA total of 34,752 weighted hospitalizations for TAVR were included in the analysis. Of the patients undergoing the procedure, 2,294 (6.6%) had a major bleed while 32,458 (93.3%) did not. At baseline, patients with coagulopathy (odds ratio [OR]: 2.03; 95% confidence interval [

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Section: Discussionsupporting

confidence: 82%

Section: Discussionmentioning

confidence: 99%

An Analysis of the Predictors of Major Bleeding After Transcatheter Aortic Valve Transplantation Using the National Inpatient Sample (2015–2018)

Khan¹,

Gilani²,

Qayum³

et al. 2021

Cureus

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“…During the procedure, there are multiple predisposing factors such as contrast use and hypotension episodes that predispose to acute renal injury [14]. As TAVR is mostly performed in elderly and frail patients, CKD has a wide prevalence and further predisposes patients to acute-on-chronic kidney injury [12,[14][15][16][17][18].…”

Section: Introductionmentioning

confidence: 99%

Acute Kidney Injury in Transcatheter Aortic Valve Replacement

Abbas¹,

Qayum²,

Wahid³

et al. 2021

Cureus

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Introduction Transcatheter aortic valve replacement (TAVR) has been established as a standard of care for patients with severe aortic stenosis. We aim to study the predictors of acute kidney injury (AKI) after TAVR from a contemporary analysis using the National Inpatient Sample (NIS) database. Methods We performed a national analysis using the NIS database to evaluate predictors of acute kidney injury (AKI) after TAVR. Our study period was from 2015 to 2018, and we identified TAVR patients in all procedure fields. Patients aged less than 18 years were excluded from the study. Results We report data of 173,760 TAVR patients, of which 20,045 (11.5%) had AKI and 153,715 (88.4%) did not. There were three principal findings of our study. First, mortality was higher in patients with AKI compared to patients who did not have AKI (8% vs. 0.8%; p<0.01). Second, patients with chronic kidney disease, weight loss, liver disease, congestive heart failure, cerebrovascular disease, chronic obstructive pulmonary disease, metastatic cancer, and peripheral vascular disease had higher adjusted odds of AKI. Third, length of stay and cost of stay were significantly higher in patients who had AKI during the index admission. Conclusion Patients with AKI had higher in-hospital mortality. We also report that at baseline, chronic kidney disease, weight loss, liver disease, congestive heart failure, cerebrovascular disease, chronic obstructive pulmonary disease, metastatic cancer, and peripheral vascular disease were important predictors of AKI in patients after TAVR. Length of stay and cost of stay were higher with AKI, which result in higher burden on the health care system due to increased resource utilization.

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“…Major bleeding or vascular complications have decreased as TAVR technology evolves into smaller device and sheath sizes [22,23] and bleeding complications are inconsistent in the early literature [24]. However, major bleeding is still associated with a three-fold increase in one-year mortality following TAVR [5][6][7]. Patients referred to TAVR are elderly, frail and at risk for both bleeding and ischemic complications [7,17,25].…”

Section: Discussionmentioning

confidence: 99%

“…Since the late 2000's, TAVR has led to constant improvement in clinical outcomes with the development of techniques and technological ameliorations along with increased operator experience. Although less prevalent compared with SAVR, the risk of major bleeding after TAVR has been estimated to be as high as approximately 6% and is associated with a three-fold increase in one-year mortality [5][6][7].…”

Section: Introductionmentioning

confidence: 99%

Bleeding risk differences after TAVR according to the ARC-HBR criteria: insights from SCOPE 2

Garot¹,

Morice²,

Tamburino³

et al. 2022

EuroIntervention

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The SCOPE 2 Trial is an investigator-initiated trial, funded by CERIC.Philippe Garot is the medical Director and a shareholder of CERC; Marie-Claude Morice is the CEO and a shareholder of CERC and a minor shareholder of Electroducer; Corrado Tamburino has received speaker fees from Medtronic; Sabine Bleiziffer has received speaker fees from Boston Scientific and Medtronic. , Michael Cunnington has received speaker and consultant fees from Medtronic; Alexander Wolf is a proctor for Boston Scientific, Edwards Lifesciences, and Medtronic; Marco Barbanti has received consultant fees from Edwards Lifesciences; ; Paolo Pagnotta is a proctor for Boston Scientific,

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Predictors of In-Hospital Mortality in Patients With End-Stage Renal Disease Undergoing Transcatheter Aortic Valve Replacement: A Nationwide Inpatient Sample Database Analysis

Cited by 14 publications

References 14 publications

An Analysis of the Predictors of Major Bleeding After Transcatheter Aortic Valve Transplantation Using the National Inpatient Sample (2015–2018)

An Analysis of the Predictors of Major Bleeding After Transcatheter Aortic Valve Transplantation Using the National Inpatient Sample (2015–2018)

Acute Kidney Injury in Transcatheter Aortic Valve Replacement

Bleeding risk differences after TAVR according to the ARC-HBR criteria: insights from SCOPE 2

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