Outcomes of transcatheter aortic-valve implantation in patients receiving chronic systemic corticosteroid treatment - 06/01/20
Résumé |
Background |
The chronic use of systemic corticosteroid (CS) therapy is associated with greater tissue fragility. Data assessing the effects of this treatment on the results of transcatheter aortic-valve implantation (TAVI) are scarce.
Purpose |
To describe the impact of chronic use of CS treatment on early and late outcomes after TAVI.
Methods and Results |
All 1299 consecutive patients undergoing TAVI in our institution between October 2006 and November 2018 were included. Their mean age was 81±10 years, 52.4% were male, their median EuroSCORE 2 was 4.7% (2.8–7.5). Among them, 48 (3.7%) received chronic systemic CS treatment at the time of the procedure and were compared to those without CS. Patients with chronic CS therapy tended to be women (60% vs. 47%, P=0.078) and needed more frequently dialysis (12.5% vs. 2.6%, P=0.002). All other baseline clinical and echocardiographic characteristics were similar between both groups. No differences were observed in 30-day mortality (6.2% vs. 4.3%, P=0.46). However, after adjustment, patients in the CS group had more frequent major vascular complications (16.7% vs. 7.4%, hazard ratio (HR) 2.52, 95%Confidence Interval (CI) 1.14–5.9; P=0.02), major or life-threatening bleedings (22.9% vs. 12.4%, HR 2.02, 95%CI 1.00–4.08; P=0.05) and tamponades (8.3% vs. 2.4%, HR 4.05, 95%CI 1.35–12.15, P<0.001) at 30 days than those in the non-CS group. At 1-year, all-cause mortality was significantly higher in CS group than in the non-CS group (37.5% vs. 12.6%, p-log rank<0.0001). Multivariate analysis confirmed that chronic use of CS was an independent predictor of 1-year all-cause mortality (HR 2.29, 95%CI: 1.16–4.50, P=0.017) (Fig. 1).
Conclusion |
Chronic systemic CS treatment was associated with an increase in major or life-threatening bleedings, major vascular complications and tamponades at 30days and was an independent predictor of 1-year all-cause mortality. This treatment should be taken into account in the risk stratification of TAVI candidates.
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Vol 12 - N° 1
P. 79 - janvier 2020 Retour au numéroBienvenue sur EM-consulte, la référence des professionnels de santé.