TY - JOUR
T1 - Pre-procedural oral anticoagulant use is associated with cardiovascular events in women after transcatheter aortic valve replacement
T2 - An analysis from the WIN-TAVI cohort
AU - van Bergeijk, Kees H.
AU - Wykrzykowska, Joanna J.
AU - Sartori, Samantha
AU - Snyder, Clayton
AU - Vogel, Birgit
AU - Tchetche, Didier
AU - Petronio, Anna S.
AU - Mehilli, Julinda
AU - Lefèvre, Thierry
AU - Presbitero, Patrizia
AU - Capranzano, Piera
AU - Iadanza, Alessandro
AU - Sardella, Gennaro
AU - van Mieghem, Nicolas M.
AU - Meliga, Emanuele
AU - Dumonteil, Nicolas
AU - Fraccaro, Chiara
AU - Trabattoni, Daniela
AU - Mikhail, Ghada
AU - Ferrer-Gracia, Maria-Cruz
AU - Naber, Christoph
AU - Kievit, Peter
AU - Sharma, Samin K.
AU - Morice, Marie-Claude
AU - Dangas, George D.
AU - Chieffo, Alaide
AU - Voors, Adriaan A.
AU - Mehran, Roxana
N1 - Funding Information: We want to thank all patients who participated in this study. The study was conducted without any external funding and was driven by the investigators' scientific interest and collaboration. Publisher Copyright: © 2022 Elsevier B.V.
PY - 2023/2/1
Y1 - 2023/2/1
N2 - Background: Transcatheter aortic valve implantation (TAVI) has become an accepted treatment for patients with severe aortic stenosis (AS). Predicting which patients are at risk for adverse clinical outcomes after TAVI remains difficult, especially in women. Aim: To identify predictors of adverse events in the WIN-TAVI cohort. Methods: The WIN-TAVI study is an observational registry of 1019 women undergoing TAVI for severe symptomatic AS. Follow-up was 1 year. The primary outcome was defined according to VARC-2: a composite of mortality, stroke, myocardial infarction or hospitalization for valve-related symptoms or heart failure. The secondary outcome was a composite of cardiovascular mortality or hospitalization for valve-related symptoms or heart failure. Results: We included 1019 women with severe AS (mean age of 82.5 ± 6.3 years). At 1 year, 16.4% of the patients experienced the primary endpoint and 12.6% the secondary endpoint. The use of oral anticoagulants (OAC) was the strongest independent predictor of the primary outcome (adjusted hazard ratio [aHR] 1.51, 95% confidence interval [CI] 1.079–2.106, p = 0.016). Independent predictors of the secondary endpoint were age (aHR 1.04 per year, 95% CI 1.01–1.074, p = 0.016) and use of OAC (aHR: 1.79, 95% CI 1.24–2.60, p = 0.002). OAC use was not associated with higher bleeding risk. Conclusion: Pre-procedural use of OAC was the strongest predictor of adverse outcomes during 1-year follow-up, likely reflecting a combination of high-risk factors and comorbidities, but was not related to increased bleeding risk.
AB - Background: Transcatheter aortic valve implantation (TAVI) has become an accepted treatment for patients with severe aortic stenosis (AS). Predicting which patients are at risk for adverse clinical outcomes after TAVI remains difficult, especially in women. Aim: To identify predictors of adverse events in the WIN-TAVI cohort. Methods: The WIN-TAVI study is an observational registry of 1019 women undergoing TAVI for severe symptomatic AS. Follow-up was 1 year. The primary outcome was defined according to VARC-2: a composite of mortality, stroke, myocardial infarction or hospitalization for valve-related symptoms or heart failure. The secondary outcome was a composite of cardiovascular mortality or hospitalization for valve-related symptoms or heart failure. Results: We included 1019 women with severe AS (mean age of 82.5 ± 6.3 years). At 1 year, 16.4% of the patients experienced the primary endpoint and 12.6% the secondary endpoint. The use of oral anticoagulants (OAC) was the strongest independent predictor of the primary outcome (adjusted hazard ratio [aHR] 1.51, 95% confidence interval [CI] 1.079–2.106, p = 0.016). Independent predictors of the secondary endpoint were age (aHR 1.04 per year, 95% CI 1.01–1.074, p = 0.016) and use of OAC (aHR: 1.79, 95% CI 1.24–2.60, p = 0.002). OAC use was not associated with higher bleeding risk. Conclusion: Pre-procedural use of OAC was the strongest predictor of adverse outcomes during 1-year follow-up, likely reflecting a combination of high-risk factors and comorbidities, but was not related to increased bleeding risk.
KW - Anticoagulants
KW - Outcome
KW - Prediction
KW - TAVI
KW - Women
UR - http://www.scopus.com/inward/record.url?scp=85143284006&partnerID=8YFLogxK
U2 - https://doi.org/10.1016/j.ijcard.2022.11.056
DO - https://doi.org/10.1016/j.ijcard.2022.11.056
M3 - Article
C2 - 36455701
SN - 0167-5273
VL - 372
SP - 40
EP - 45
JO - International journal of cardiology
JF - International journal of cardiology
ER -