Trends and Predictors of Transcatheter Aortic Valve Implantation Related In-Hospital Mortality (From the National Inpatient Sample Database)

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Existing surgical aortic valve replacement risk models accurately predict the post- surgical aortic valve replacement morbidity and mortality, but factors associated with post transcatheter aortic valve Implantation (TAVI) mortality are not well known. The National Inpatient Sample was queried to identify all cases of TAVI. The association of baseline comorbidities with in-hospital mortality was determined using a binary logistic regression model to obtain adjusted odds ratios (aOR). A total of 161,049 patients underwent TAVI between 2010 and 2017. Of these, 157,151 (97.6%) survived while 3,898 (2.4%) died during hospitalization. The baseline characteristics of TAVI-survivors and non-survivors showed a significant amount of variation, including age (80 vs 82 years, p ≤ 0.0001) and female sex (46% vs 52%, p ≤ 0.0001), respectively. The non-survivors had significantly higher adjusted odds of renal failure requiring hemodialysis (aOR 2.59, 95% CI 2.24 to 2.99, p ≤ 0.0001), history of mediastinal radiation (aOR 2.71, 95% CI 1.02 to 7.20, p = 0.05), liver disease (aOR 3.04, 95% CI 2.63 to 3.51, p ≤ 0.0001), pneumonia (aOR 2.47, 95% CI 2.15 to 2.83, p ≤ 0.0001), cardiogenic shock (aOR 9.83, 95% CI 8.93 to 10.82, p ≤ 0.0001), ventricular tachycardia (aOR 2.12, 95% CI 1.88 to 2.40, p ≤ 0.0001), acute ST-elevation myocardial infarction (aOR 7.38, 95% CI 5.53 to 9.84, p ≤ 0.0001), stroke (aOR 2.25, 95% CI 1.99 to 2.54, p ≤ 0.0001), and acute infective endocarditis (aOR 5.74, 95% CI 3.65 to 9.02, p ≤ 0.0001) compared to TAVI-survivors. The yearly trend of mortality showed an increase in the absolute number of TAVI procedures and mortality but the yearly rate showed a decline in mortality after an initial peak during 2012.Patients with renal failure on dialysis, ST-elevation myocardial infarction, cardiogenic shock, infective endocarditis, liver disease and pneumonia have a higher rate of in-hospital mortality post TAVI.

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Methods

We retrospectively analyzed data from the National Inpatient Sample (NIS) Database. NIS is a large national database to allow for the national assessment of hospital discharges among patients of different age groups across all payer types from all United States (US) hospitals. The included data is completely de-identified and hence exempted from approval by the institutional review board. NIS contains data from almost 20 million discharges each year, representing more than a 100 million

Results

A total of 161,049 patients who underwent TAVI were included in the analysis. Of these, 3,898 (2.4%) patients died and 157,151 (97.6%) survived the hospitalization. There were significant intergroup differences in the baseline characteristics as shown in Table 1. The mortality trend across different years showed an initial peak in the annual percent mortality during 2012 and then a gradual decline. There has been an exponential increase in the absolute number of TAVI procedures in recent years

Discussion

The present study included more than 160,000 TAVI patients from the largest available US clinical registry (2002 to 2017). Assessment of the prespecified risk factors as devised by STS revealed significant variation in its associations with TAVI-related mortality. TAVI patients with a previous history of mediastinal radiation, liver disease and third-degree heart block showed significantly higher odds of in-hospital mortality. Similarly, patients with a concurrent diagnosis of periprocedural

Authors’ Contributions

Waqas Ullah MD: conceptualization, methodology, formal analysis, writing - review & editing; Salman Zahid MD: data curation; Ihab Hamzeh: validation, editing; Yochai Birnbaum: project administration, editing; Salim S. Virani: visualization and supervision; Mahboob Alam: critical review and supervision.

Disclosures

The authors have no conflicts of interest to disclose.

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Research support: Department of Veterans Affairs, World Heart Federation, Tahir and Jooma Family Honorarium: American College of Cardiology (Associate Editor for Innovations, acc.org).

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