Impact of anemia on short‐term outcomes after <scp>TAVR</scp>: A subgroup analysis from the <scp>BRAVO</scp>‐3 randomized trial

Razuk, Victor; Camaj, Anton; Cao, Davide; Nicolas, Johny; Hengstenberg, Christian; Sartori, Samantha; Zhang, Zhongjie; Power, David; Beerkens, Frans; Chiarito, Mauro; Méneveau, Nicolas; Tron, Christophe; Dumonteil, Nicolas; Widder, Julian; Ferrari, Markus; Violini, Roberto; Stella, Pieter R.; Jeger, Raban; Anthopoulos, Prodromos; Mehran, Roxana; Dangas, George

doi:10.1002/ccd.29753

Cited by 3 publications

(5 citation statements)

References 36 publications

(101 reference statements)

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“…The review included five multicenter and six single-center observational studies. A prospective design was reported in five studies [ 6 , 9 , 15 , 16 , 17 ]. All studies had a sample size of >100 anemic patients (range: 169–1335 patients).…”

Section: Resultsmentioning

confidence: 99%

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Impact of Baseline Anemia in Patients Undergoing Transcatheter Aortic Valve Replacement: A Prognostic Systematic Review and Meta-Analysis

Jiménez-Xarrié,

Asmarats,

Roqué-Figuls

et al. 2023

JCM

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Transcatheter aortic valve replacement (TAVR) is currently the treatment of choice for patients aged ≥75 years with severe aortic stenosis. Preoperative anemia is present in a large proportion of patients and may increase the risk of post-procedural complications. The purpose of this prognostic systematic review was to analyze the impact of baseline anemia on short- and mid-term outcomes following TAVR. A computerized search was performed on PubMed and Web of Science databases for studies published between January 2013 and December 2022. Primary outcomes were 30-day need for transfusion, acute renal failure, 30-day and mid-term mortality, and readmission during the first year post-TAVR. Data were analyzed via random effects model using inverse variance method with 95% confidence intervals. Eleven observational studies met our eligibility criteria and included a total of 12,588 patients. The prevalence of baseline anemia ranged between 39% and 72%, with no relevant sex differences. Patients with preprocedural anemia received more blood transfusions [OR: 2.95 (2.13–4.09)]), and exhibited increased rates of acute kidney injury [OR:1.74 (1.45–2.10)], short-term mortality [OR: 1.47 (1.07–2.01], and mid-term [OR: 1.89 (1.58–2.25)] mortality following TAVR compared with those without anemia. Baseline anemia determined an increased risk for blood transfusion, acute kidney injury, and short/mid-term mortality among TAVR recipients.

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Section: Resultsmentioning

confidence: 99%

“… Forest plots showing pre-procedural anemia and associated odds of 30-day transfusion ( a ), acute renal failure ( b ), 30-day mortality ( c ) and mid-term mortality ( d ) [ 6 , 9 , 10 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 ]. Asterisk indicates reported adjusted odds ratio [ 10 , 16 , 21 ].…”

Section: Figurementioning

confidence: 99%

Impact of Baseline Anemia in Patients Undergoing Transcatheter Aortic Valve Replacement: A Prognostic Systematic Review and Meta-Analysis

Jiménez-Xarrié,

Asmarats,

Roqué-Figuls

et al. 2023

JCM

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“…The reference Hgb values for defining anemia are largely based on the definition provided by the World Health Organization (WHO) in 1968 ( 9 ). The presence of underlying anemia is linked with poor outcomes in cardiac patients including coronary artery disease and congestive heart failure, patients undergoing transcatheter aortic valve replacement, and patients undergoing PCI including in-hospital and long-term adverse events ( 3 , 5 , 8 , 10 – 12 ). In the context of acute coronary syndrome, anemia exacerbates the mismatch between myocardial oxygen supply and demand by reducing oxygen-carrying capacity and simultaneously increasing myocardial consumption through increased cardiac output ( 13 ).…”

Section: Introductionmentioning

confidence: 99%

Implications of anemia in patients undergoing PCI with Impella-support: insights from the PROTECT III study

Falah,

Redfors,

Zhao

et al. 2024

Front. Cardiovasc. Med.

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BackgroundAnemia is prevalent among patients with cardiovascular disease and is associated with adverse outcomes. However, data regarding the impact of anemia in high-risk percutaneous coronary intervention (HRPCI) are limited.ObjectivesThis study aimed to evaluate the impact of anemia in patients undergoing Impella-supported HRPCI in the PROTECT III study.MethodsPatients undergoing Impella-supported HRPCI in the multicenter PROTECT III study were assessed for anemia based on baseline hemoglobin levels according to World Health Organization criteria. Patients were stratified into three groups, namely, no anemia, mild anemia, and moderate or severe anemia. Major adverse cardiovascular and cerebrovascular events (MACCE: all-cause death, myocardial infarction, stroke/transient ischemic attack, and repeat revascularization) at 30 and 90 days, and major bleeding events were compared across groups.ResultsOf 1,071 patients with baseline hemoglobin data, 37.9% had no anemia, 43.4% had mild anemia, and 18.7% had moderate or severe anemia. Anemic patients were older and more likely to have comorbidities. Anemia was associated with higher MACCE rates at 30 days (moderate to severe, 12.3%; mild, 9.8%; no anemia, 5.4%; p = 0.02) and at 90 days (moderate to severe, 18.7%; mild, 14.6%; none, 8.3%; p = 0.004). These differences persisted after adjustment for potential confounders at 30 and 90 days, and sensitivity analysis excluding dialysis showed similar results. Major bleeding at 30 days was also higher in anemic patients (5.5% vs. 1.2%, p = 0.002).ConclusionBaseline anemia in Impella-supported HRPCI is common and independently associated with MACCE and major bleeding, emphasizing its significance as a prognostic factor. Specific management strategies to reduce anemia-associated MACCE risk after HRPCI should be examined.Clinical Trial InformationTrial Name: The Global cVAD Study (cVAD)ClinicalTrial.gov Identifier: NCT04136392URL: https://clinicaltrials.gov/ct2/show/NCT04136392?term=cvad&draw=2&rank=2

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“… 2 3 For instance, former studies have shown that preoperative anaemia is associated with an increased risk of post-TAVI mortality and adverse clinical outcomes. 4 5 …”

Section: Introductionmentioning

confidence: 99%

“…Several studies have been undertaken to understand the prognostic value of different comorbidities and biomarkers on TAVI outcomes 2 3. For instance, former studies have shown that preoperative anaemia is associated with an increased risk of post-TAVI mortality and adverse clinical outcomes 4 5…”

Section: Introductionmentioning

confidence: 99%

Association between haematological parameters and outcomes following transcatheter aortic valve implantation at mid-term follow-up

et al. 2022

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BackgroundPatients undergoing transcatheter aortic valve implantation (TAVI) often have multiple comorbidities, such as anaemia and chronic inflammatory disorders. We sought to investigate the association between preoperative and postoperative haematological parameters and clinical outcomes in TAVI patients at mid-term follow-up.MethodsIn the present study, consecutive patients (N=908) who underwent TAVI at the Cleveland Clinic between 2017 and 2019 with available complete blood counts were studied. Data were collected on preoperative and postoperative anaemia and elevations in neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR). Survival analysis was used to study the association of haematologic parameters with all-cause mortality and major adverse cardiac and cerebrovascular events (MACCE).ResultsWe found that preoperative anaemia and elevated NLR were significantly associated with a higher risk of all-cause mortality (aHR=1.6 (95% CI: 1.1 to 2.0) and 1.4 (95% CI: 1.1 to 1.6), respectively) and MACCE (aHR=1.9 (95% CI: 1.3 to 2.8) and 1.6 (95% CI: 1.1 to 2.4), respectively). While an elevated preoperative PLR was not associated with increased mortality risk, it had a significant association with MACCE risk (aHR: 1.6 (95% CI: 1.1 to 2.4)). Further, postoperative anaemia, elevated NLR and PLR were associated with increased risks of all-cause mortality and MACCE.ConclusionPathological alterations in haematological parameters were associated with higher risks of post-TAVI mortality and MACCE at mid-term follow-up. Our findings advocate for further incorporating haematological parameters in the preoperative evaluation of TAVI candidates.

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Impact of anemia on short‐term outcomes after TAVR: A subgroup analysis from the BRAVO‐3 randomized trial

Cited by 3 publications

References 36 publications

Impact of Baseline Anemia in Patients Undergoing Transcatheter Aortic Valve Replacement: A Prognostic Systematic Review and Meta-Analysis

Impact of Baseline Anemia in Patients Undergoing Transcatheter Aortic Valve Replacement: A Prognostic Systematic Review and Meta-Analysis

Implications of anemia in patients undergoing PCI with Impella-support: insights from the PROTECT III study

Association between haematological parameters and outcomes following transcatheter aortic valve implantation at mid-term follow-up

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