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Chandrasekhar J, Sartori S, Mehran R, Aquino M, Vogel B, Asgar AW, Webb JG, Tchetche D, Dumonteil N, Colombo A, Windecker S, Claessen BE, Ten Berg JM, Hildick-Smith D, Wijngaard P, Lefèvre T, Deliargyris EN, Hengstenberg C, Anthopoulos P, Dangas GD. Incidence, predictors, and outcomes associated with acute kidney injury in patients undergoing transcatheter aortic valve replacement: from the BRAVO-3 randomized trial. Clin Res Cardiol 2021; 110:649-657. [PMID: 33839885 DOI: 10.1007/s00392-020-01787-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2019] [Accepted: 11/24/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND Acute kidney injury (AKI) is not uncommon in patients undergoing transcatheter aortic valve replacement (TAVR). OBJECTIVE We examined the incidence, predictors, and outcomes of AKI from the BRAVO 3 randomized trial. METHODS The BRAVO-3 trial included 802 patients undergoing transfemoral TAVR randomized to bivalirudin vs. unfractionated heparin (UFH). The primary endpoint of the trial was Bleeding Academic Research Consortium (BARC) type ≥ 3b bleeding at 48 h. Total follow-up was to 30 days. AKI was adjudicated using the modified RIFLE (Valve Academic Research Consortium, VARC 1) criteria through 30-day follow-up, and in a sensitivity analysis AKI was assessed at 7 days (modified VARC-2 criteria). We examined the incidence, predictors, and 30-day outcomes associated with diagnosis of AKI. We also examined the effect of procedural anticoagulant (bivalirudin or unfractionated heparin, UFH) on AKI within 48 h after TAVR. RESULTS The trial population had a mean age of 82.3 ± 6.5 years including 48.8% women with mean EuroScore I 17.05 ± 10.3%. AKI occurred in 17.0% during 30-day follow-up and was associated with greater adjusted risk of 30-day death (13.0% vs. 3.5%, OR 5.84, 95% CI 2.62-12.99) and a trend for more BARC ≥ 3b bleeding (15.1% vs. 8.6%, OR 1.80, 95% CI 0.99-3.25). Predictors of 30-day AKI were baseline hemoglobin, body weight, and pre-existing coronary disease. AKI occurred in 10.7% at 7 days and was associated with significantly greater risk of 30-day death (OR 6.99, 95% CI 2.85-17.15). Independent predictors of AKI within 7 days included pre-existing coronary or cerebrovascular disease, chronic kidney disease (CKD), and transfusion which increased risk, whereas post-dilation was protective. The incidence of 48-h AKI was higher with bivalirudin compared to UFH in the intention to treat cohort (10.9% vs. 6.5%, p = 0.03), but not in the per-protocol assessment (10.7% vs. 7.1%, p = 0.08). CONCLUSION In the BRAVO 3 trial, AKI occurred in 17% at 30 days and in 10.7% at 7 days. AKI was associated with a significantly greater adjusted risk for 30-day death. Multivariate predictors of AKI at 30 days included baseline hemoglobin, body weight, and prior coronary artery disease, and predictors at 7 days included pre-existing vascular disease, CKD, transfusion, and valve post-dilation. Bivalirudin was associated with greater AKI within 48 h in the intention to treat but not in the per-protocol analysis.
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Affiliation(s)
- Jaya Chandrasekhar
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, USA.,Department of Cardiology, Box Hill Hospital, Eastern Health Clinical School, Monash University, Melbourne, Australia
| | - Samantha Sartori
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Roxana Mehran
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, USA.,Mount Sinai Medical Center, One Gustave L. Levy Place, Box 1030, New York, NY, 10029, USA
| | - Melissa Aquino
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Birgit Vogel
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Anita W Asgar
- Institut de Cardiologie de Montreal, Montreal, Canada
| | | | | | | | | | | | - Bimmer E Claessen
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, USA
| | | | | | | | | | | | | | | | - George D Dangas
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, USA. .,Mount Sinai Medical Center, One Gustave L. Levy Place, Box 1030, New York, NY, 10029, USA.
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Wang TY, Gracia E, Callahan S, Bilfinger T, Tannous H, Pyo R, Kort S, Skopicki H, Weinstein J, Patel N, Montellese D, Korlipara G, Khan S, Chikwe J, Parikh PB. Gender Disparities in Management and Outcomes Following Transcatheter Aortic Valve Implantation With Newer Generation Transcatheter Valves. Am J Cardiol 2019; 123:1489-1493. [PMID: 30782416 DOI: 10.1016/j.amjcard.2019.01.048] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2018] [Revised: 01/19/2019] [Accepted: 01/22/2019] [Indexed: 01/09/2023]
Abstract
The impact of gender on management and early outcomes after transcatheter aortic valve implantation (TAVI) in the setting of newer generation transcatheter heart valves (THVs) is not well known. We evaluated gender-specific differences on clinical management and in-hospital outcomes in adults who underwent TAVI with newer generation THVs. The study population included 298 consecutive patients who underwent TAVI and received a newer generation THV (Sapien 3 [Edwards Lifesciences, Irvine, California] or Corevalve Evolut R or Evolut Pro [Medtronic, Minneapolis, Minnesota]) from December 2015 to June 2018 at an academic tertiary medical center. Of the 298 patients, 154 (52%) were men and 144 (48%) were women. Compared with men, women were older, had lower serum creatinine, higher left ventricular ejection fraction, and lower rates of multiple co-morbidities, including previous coronary artery bypass graft surgery, previous myocardial infarction, and atrial fibrillation. Women were noted to have smaller aortic annular area and perimeter and underwent implantation of smaller THVs than men. At the time of discharge, women were more frequently prescribed a P2Y12 inhibitor (primarily clopidogrel) and less frequently prescribed oral anticoagulation (namely warfarin). Hospital length of stay and in-hospital rates of mortality, disabling stroke, and pacemaker were similar in men and women. In conclusion, in this observational prospective study of adults who underwent TAVI with newer generation THVs, while gender-related disparities in clinical presentation and procedural management were observed, no significant difference in clinical outcomes were noted in men and women. Further studies examining gender-related differences in procedural and postprocedural care after TAVI in the contemporary era are warranted to better understand and optimize clinical outcomes in both men and women.
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Affiliation(s)
- Ting-Yu Wang
- Division of Cardiovascular Medicine, Department of Medicine, State University of New York at Stony Brook, Stony Brook, New York
| | - Ely Gracia
- Division of Cardiovascular Medicine, Department of Medicine, State University of New York at Stony Brook, Stony Brook, New York
| | - Susan Callahan
- Division of Cardiothoracic Surgery, Department of Medicine, State University of New York at Stony Brook, Stony Brook, New York
| | - Thomas Bilfinger
- Division of Cardiothoracic Surgery, Department of Medicine, State University of New York at Stony Brook, Stony Brook, New York
| | - Henry Tannous
- Division of Cardiothoracic Surgery, Department of Medicine, State University of New York at Stony Brook, Stony Brook, New York
| | - Robert Pyo
- Division of Cardiovascular Medicine, Department of Medicine, State University of New York at Stony Brook, Stony Brook, New York
| | - Smadar Kort
- Division of Cardiovascular Medicine, Department of Medicine, State University of New York at Stony Brook, Stony Brook, New York
| | - Hal Skopicki
- Division of Cardiovascular Medicine, Department of Medicine, State University of New York at Stony Brook, Stony Brook, New York
| | - Jonathan Weinstein
- Division of Cardiovascular Medicine, Department of Medicine, State University of New York at Stony Brook, Stony Brook, New York
| | - Neal Patel
- Division of Cardiovascular Medicine, Department of Medicine, State University of New York at Stony Brook, Stony Brook, New York
| | - Daniel Montellese
- Division of Cardiovascular Medicine, Department of Medicine, State University of New York at Stony Brook, Stony Brook, New York
| | - Giridhar Korlipara
- Division of Cardiovascular Medicine, Department of Medicine, State University of New York at Stony Brook, Stony Brook, New York
| | - Shamim Khan
- Division of Cardiovascular Medicine, Department of Medicine, State University of New York at Stony Brook, Stony Brook, New York
| | - Joanna Chikwe
- Division of Cardiothoracic Surgery, Department of Medicine, State University of New York at Stony Brook, Stony Brook, New York
| | - Puja B Parikh
- Division of Cardiovascular Medicine, Department of Medicine, State University of New York at Stony Brook, Stony Brook, New York.
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Ge Z, Chandrasekhar J, Mehran R. Use of Bivalirudin for Anticoagulation in Interventional Cardiovascular Procedures. CARDIOVASCULAR INNOVATIONS AND APPLICATIONS 2018. [DOI: 10.15212/cvia.2017.0045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Patel PA, Patel S, Feinman JW, Gutsche JT, Vallabhajosyula P, Shah R, Giri J, Desai ND, Zhou E, Weiss SJ, Augoustides JG. Stroke After Transcatheter Aortic Valve Replacement: Incidence, Definitions, Etiologies and Management Options. J Cardiothorac Vasc Anesth 2018; 32:968-981. [DOI: 10.1053/j.jvca.2017.08.034] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2017] [Indexed: 11/11/2022]
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Pacheco C, Henri C, Forcillo J, Asgar AW. Transcatheter Aortic Valve Replacement for Severe Aortic Stenosis in Women: Clinical Characteristics and Outcomes. Can J Cardiol 2018; 34:422-428. [PMID: 29395700 DOI: 10.1016/j.cjca.2017.10.026] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2017] [Revised: 10/26/2017] [Accepted: 10/30/2017] [Indexed: 02/07/2023] Open
Abstract
Aortic stenosis (AS), 1 of the most common valve diseases in developed countries, carries a poor prognosis if left untreated. Transcatheter aortic valve replacement (TAVR) has become the standard of care for high-risk and inoperable patients with severe aortic stenosis (AS). Women represent a significant proportion of patients with severe AS and demonstrate specific clinical, anatomic, and pathophysiological features that are evident both before and after valve replacement. In this review, we discuss these features as well as the outcomes of women undergoing TAVR for AS.
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Affiliation(s)
- Christine Pacheco
- Department of Cardiology, Institut de Cardiologie de Montréal, Université de Montréal, Montréal, Canada
| | - Christine Henri
- Department of Cardiology, Institut de Cardiologie de Montréal, Université de Montréal, Montréal, Canada
| | - Jessica Forcillo
- Department of Cardiology, Institut de Cardiologie de Montréal, Université de Montréal, Montréal, Canada
| | - Anita W Asgar
- Department of Cardiology, Institut de Cardiologie de Montréal, Université de Montréal, Montréal, Canada.
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Mina GS, Firouzbakht T, Modi K, Dominic P. Gender-based outcomes of bivalirudin versus heparin in patients undergoing percutaneous coronary interventions: Meta-analysis of randomized controlled trials. Catheter Cardiovasc Interv 2017; 90:735-742. [PMID: 28339139 DOI: 10.1002/ccd.26985] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2016] [Revised: 10/26/2016] [Accepted: 01/22/2017] [Indexed: 01/26/2023]
Abstract
OBJECTIVES We aimed to perform a gender-based meta-analysis of the outcome of bivalirudin versus heparin in patients undergoing percutaneous coronary interventions (PCI). BACKGROUND Bivalirudin has been shown to decrease major bleeding when compared to heparin ± glycoprotein IIb/IIIa inhibitors (GPI) in patients undergoing PCI. It is unclear, however, if those differences in outcomes are the same for men and women. METHODS We included randomized controlled trials (RCTs) that compared bivalirudin to heparin with or without GPI in patients undergoing PCI and reported outcome data that were stratified by gender. Random effect model was used to pool odds ratio (OR) and 95% confidence intervals (CI). RESULTS We included 9 trials with 33,224 patients. Bivalirudin decreased major bleeding when compared to heparin plus routine GPI in both men (OR: 0.51, P < 0.001) and women (OR: 0.55, P < 0.001). However, when GPI were used selectively with heparin, the bleeding lowering effect of bivalirudin was statistically significant in men (OR: 0.69, P = 0.02) but not in women (OR: 0.71, P = 0.21). When compared to heparin ± GPI, there was a nonstatistically significant trend toward lower all-cause mortality with bivalirudin in both men (OR: 0.76, P = 0.055) and women (OR: 0.79, P = 0.21). There were no significant differences in major adverse cardiovascular events between heparin and bivalirudin in both men and women. CONCLUSION Bivalirudin decreases major bleeding in both men and women when compared to heparin plus routine GPI. However, when compared to heparin alone, the bleeding lowering benefit of bivalirudin is less evident in women. © 2017 Wiley Periodicals, Inc.
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Affiliation(s)
- George S Mina
- Department of Cardiology, LSUHSC-Shreveport, Shreveport, Louisiana
| | - Tina Firouzbakht
- Department of Medicine, LSUHSC-Shreveport, Shreveport, Louisiana
| | - Kalgi Modi
- Department of Cardiology, LSUHSC-Shreveport, Shreveport, Louisiana
| | - Paari Dominic
- Department of Cardiology, LSUHSC-Shreveport, Shreveport, Louisiana
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