Prognostic impact of baseline C‐reactive protein levels on mortality after transcatheter aortic valve implantation

Abstract

Objectives: To determine whether baseline C-reactive protein (CRP) levels can predict mortality after transcatheter aortic valve implantation (TAVI), we performed a meta-analysis of currently available studies.Methods: All studies investigating the prognostic impact of baseline (preprocedural) CRP levels on all-cause mortality after TAVI were identified by means of searching PubMed and Google Scholar through May 2019. For each study, (preferentially, adjusted rather than unadjusted) odds/hazard ratios (ORs/HRs) with corresponding 95% confidence intervals of mortality per standard-deviation (SD) (or unit) increase in CRP levels or those for high vs low CRP levels.Results: Our search identified 14 eligible studies including a total of 3449 patients undergoing TAVI and reporting early (in-hospital to 3-month) and midterm (1-year to 3-year) all-cause mortality after TAVI. Pooled analyses demonstrated associations of high-baseline CRP levels with a marginal, but statistically nonsignificant increase in early mortality (pooled OR/HR per SD increase in CRP levels, 2.72; P = .09 and pooled OR/HR for high vs low CRP levels, 3.32; P = .07) and a statistically significant increase in midterm mortality after TAVI (pooled OR/HR per SD increase in CRP levels, 1.45; P < .0001 and pooled OR/HR for high vs low CRP levels, 1.78; P < .00001). Excluding HRs for high-sensitivity CRP, combining ORs/HRs of 1-year mortality, pooling HRs of ≥2-year mortality, and combining adjusted HRs did not alter the primary results. Conclusion:High-baseline CRP levels may predict increased midterm, but not early, mortality after TAVI. K E Y W O R D SC-reactive protein, meta-analysis, mortality, transcatheter aortic valve implantation

Risk assessment in patients with left ventricular systolic dysfunction following transcatheter aortic valve replacement

“…In addition to moderate or greater tricuspid regurgitation, higher serum C‐reactive protein was a significant risk factor of mortality in this study, although it did not reach statistical significance in the multivariate analysis. Similarly, a meta‐analysis of 14 studies including 3499 TAVR candidates demonstrated that a baseline higher C‐reactive protein level was associated with midterm all‐cause mortality 6 . Elevated C‐reactive protein might indicate advanced cardiac cachexia among other clinical conditions, thus explaining the reported poor outcomes following TAVR.…”

“…Similarly, a meta-analysis of 14 studies including 3499 TAVR candidates demonstrated that a baseline higher C-reactive protein level was associated with midterm all-cause mortality. 6 Elevated C-reactive protein might indicate advanced cardiac cachexia among other clinical conditions, thus explaining the reported poor outcomes following TAVR.…”

Prognostic Value of Systemic Immune-Inflammation Index for Major Adverse Cardiac Events and Mortality in Severe Aortic Stenosis Patients after TAVI

“…Prior studies showed that chronic inflammation might be related to increased mortality in AS patients following TAVI [5]. Condado et al showed that neutrophil-lymphocyte ratio and platelet-lymphocyte ratio could be used to risk-stratify AS patients after TAVI [16].…”

“…Currently, transcatheter aortic valve implantation (TAVI) is an alternative treatment option to surgical aortic valve implantation in patients with inoperable and high-risk severe symptomatic AS [3]. Prior studies revealed that several biomarkers, such as galectin-3, growth differentiation factor-15, microRNAs, and brain natriuretic peptides, were known to predict outcomes after TAVI [4,5]. Moreover, in a meta-analysis of 14 studies including 3449 TAVI patients, high-baseline inflammatory status, assessed by C-reactive protein (CRP) levels, may predict increased mid-term mortality following TAVI [5].…”

C-reactive protein predicts early clinical outcomes and long-term mortality after left ventricular assisted device

“…[6][7][8] Elevated pre-implant CRP levels are also associated with increased postoperative complications, hospital length of stay (HLOS), all-cause death, and longterm mortality in patients after various cardiovascular interventions. [9][10][11][12] Besides, in patients with HF, high CRP levels correlate with more severe symptoms and are independently associated with increased mortality and morbidity. 13 A recent study demonstrated that pre-implant CRP could predict postoperative complications and mortality in patients with LVAD support.…”