TY - JOUR
T1 - Bleeding in Patients Undergoing Transfemoral Transcatheter Aortic Valve Replacement
T2 - Incidence, Trends, Clinical Outcomes, and Predictors
AU - van Nieuwkerk, Astrid C.
AU - Aarts, Hugo M.
AU - Hemelrijk, Kimberley I.
AU - Cantón, Tomás
AU - Tchétché, Didier
AU - de Brito, Fabio S.
AU - Barbanti, Marco
AU - Kornowski, Ran
AU - Latib, Azeem
AU - D'Onofrio, Augusto
AU - Ribichini, Flavio
AU - Maneiro Melón, Nicolas
AU - Dumonteil, Nicolas
AU - Abizaid, Alexandre
AU - Sartori, Samantha
AU - D'Errigo, Paola
AU - Tarantini, Giuseppe
AU - Fabroni, Margherita
AU - Orvin, Katia
AU - Pagnesi, Matteo
AU - Vicaino Arellano, Manuel
AU - Dangas, George
AU - Mehran, Roxana
AU - Voskuil, Michiel
AU - Delewi, Ronak
N1 - Publisher Copyright:
© 2023 American College of Cardiology Foundation
PY - 2023/12/25
Y1 - 2023/12/25
N2 - Background: Bleeding is one of the most frequent complications in patients undergoing transcatheter aortic valve replacement (TAVR). Importantly, major bleeding is associated with poor clinical outcomes after TAVR. However, large studies on bleeding complications in the contemporary TAVR population are limited. Objectives: The aim of this study was to assess the incidence, temporal trends, clinical outcomes, and predictors of bleeding in patients undergoing transfemoral TAVR. Methods: The CENTER2 study is a pooled patient-level database from 10 clinical studies including patients who underwent TAVR between 2007 and 2022. Results: A total of 23,562 patients underwent transfemoral TAVR. The mean age was 81.5 ± 6.7 years, and 56% were women. Major bleeding within the first 30 days was observed in 1,545 patients (6.6%). Minor bleeding was reported in 1,143 patients (4.7%). Rates of major bleeding decreased from 11.5% in 2007-2010 to 5.5% in 2019-2022 (Ptrend < 0.001). Dual antiplatelet therapy was associated with higher major bleeding rates compared with single antiplatelet therapy (12.2% vs 9.1%; OR: 1.40; 95% CI: 1.13-1.72; P = 0.002). Patients with major bleeding had increased mortality risk during the first 30 days (14.1% vs 4.3%; OR: 3.66; 95% CI: 3.11-4.31; P < 0.001) and during 1-year follow-up (27.8% vs 14.5%; HR: 1.50; 95% CI: 1.41-1.59; P < 0.001). Minor bleeding did not affect 1-year mortality risk (16.7% vs 14.5%; HR: 1.11; 95% CI: 0.93-1.32; P = 0.27). Predictors of major bleeding were female sex and peripheral vascular disease. Conclusions: Bleeding complications remain frequent and important in patients undergoing transfemoral TAVR. Increased mortality risk in major bleeding persists after the initial 30 days.
AB - Background: Bleeding is one of the most frequent complications in patients undergoing transcatheter aortic valve replacement (TAVR). Importantly, major bleeding is associated with poor clinical outcomes after TAVR. However, large studies on bleeding complications in the contemporary TAVR population are limited. Objectives: The aim of this study was to assess the incidence, temporal trends, clinical outcomes, and predictors of bleeding in patients undergoing transfemoral TAVR. Methods: The CENTER2 study is a pooled patient-level database from 10 clinical studies including patients who underwent TAVR between 2007 and 2022. Results: A total of 23,562 patients underwent transfemoral TAVR. The mean age was 81.5 ± 6.7 years, and 56% were women. Major bleeding within the first 30 days was observed in 1,545 patients (6.6%). Minor bleeding was reported in 1,143 patients (4.7%). Rates of major bleeding decreased from 11.5% in 2007-2010 to 5.5% in 2019-2022 (Ptrend < 0.001). Dual antiplatelet therapy was associated with higher major bleeding rates compared with single antiplatelet therapy (12.2% vs 9.1%; OR: 1.40; 95% CI: 1.13-1.72; P = 0.002). Patients with major bleeding had increased mortality risk during the first 30 days (14.1% vs 4.3%; OR: 3.66; 95% CI: 3.11-4.31; P < 0.001) and during 1-year follow-up (27.8% vs 14.5%; HR: 1.50; 95% CI: 1.41-1.59; P < 0.001). Minor bleeding did not affect 1-year mortality risk (16.7% vs 14.5%; HR: 1.11; 95% CI: 0.93-1.32; P = 0.27). Predictors of major bleeding were female sex and peripheral vascular disease. Conclusions: Bleeding complications remain frequent and important in patients undergoing transfemoral TAVR. Increased mortality risk in major bleeding persists after the initial 30 days.
KW - aortic valve stenosis
KW - bleeding
KW - mortality
KW - transcatheter aortic valve replacement
UR - http://www.scopus.com/inward/record.url?scp=85178237361&partnerID=8YFLogxK
U2 - 10.1016/j.jcin.2023.10.011
DO - 10.1016/j.jcin.2023.10.011
M3 - Article
AN - SCOPUS:85178237361
SN - 1936-8798
VL - 16
SP - 2951
EP - 2962
JO - JACC: Cardiovascular Interventions
JF - JACC: Cardiovascular Interventions
IS - 24
ER -