Outcomes of urgent versus nonurgent transcatheter aortic valve replacement

Ayman Elbadawi, Islam Y. Elgendy, Amgad Mentias, Marwan Saad, Ahmed H. Mohamed, Muhammad Waqas Choudhry, Gbolahan O. Ogunbayo, Syed Gilani, Hani Jneid

Research output: Contribution to journalArticle

Abstract

Background: There is a paucity of data regarding the outcomes of transcatheter valve replacement (TAVR) performed in an urgent clinical setting. Methods: The Nationwide Inpatient Sample (NIS) database years 2011–2014 was used to identify hospitalizations for TAVR in the urgent setting. Using propensity score matching, we compared patients who underwent TAVR in nonurgent versus urgent settings. Results: Among 42,154 hospitalizations in which TAVR was performed, 10,114 (24%) underwent urgent TAVR. There was an uptrend in the rate of urgent TAVR procedures (p =.001). The rates of in-hospital mortality among this group did not change during the study period (p =.713). Nonurgent TAVR was associated with lower mortality (odds ratio [OR] = 0.78; 95% confidence interval [CI]: 0.69–0.89, p <.001) compared with urgent TAVR. Nonurgent TAVR was associated with lower incidence of cardiogenic shock (OR = 0.46; 95%CI: 0.40–0.53 p <.001), use of mechanical circulatory support devices (OR = 0.69; 95%CI: 0.59–0.82, p <.001), AKI (OR = 0.60; 95%CI: 0.56–0.64 p <.001), hemodialysis (OR = 0.67; 95%CI: 0.56–0.80 p <.001), major bleeding (OR = 0.94; 95%CI: 0.89–0.99 p =.045) and shorter length of stay (7.08 ± 6.317 vs. 12.39 ± 9.737 days, p <.001). There was no difference in acute stroke (OR = 0.96; 95%CI: 0.81–1.14, p =.636), vascular complications (OR = 1.07; 95%CI: 0.89–1.29, p =.492), and pacemaker insertions (OR = 0.92; 95%CI: 0.84–1.01, p =.067) between both groups. Among those undergoing urgent TAVR, subgroup analysis showed higher mortality in patients ≤80 years (p =.033), women (p <.001), chronic kidney disease (p =.001), heart failure (p <.001), and liver disease (p =.003). Conclusion: In this large nationwide analysis, almost a quarter of TAVR procedures were performed in the urgent settings. Although urgent TAVR was associated with higher mortality and increased complications compared with nonurgent TAVR, the absolute difference in in-hospital mortality was not remarkably higher. Thus, urgent TAVR can be considered as a reasonable approach when indicated.

Original languageEnglish (US)
JournalCatheterization and Cardiovascular Interventions
DOIs
StateAccepted/In press - Jan 1 2019

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Odds Ratio
Confidence Intervals
Hospital Mortality
Mortality
Hospitalization
Transcatheter Aortic Valve Replacement
Propensity Score
Cardiogenic Shock
Chronic Renal Insufficiency
Blood Vessels
Renal Dialysis
Liver Diseases
Inpatients
Length of Stay
Heart Failure
Stroke
Databases
Hemorrhage
Equipment and Supplies
Incidence

Keywords

  • decompensated aortic stenosis
  • transcatheter aortic valve replacement
  • urgent

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine

Cite this

Elbadawi, A., Elgendy, I. Y., Mentias, A., Saad, M., Mohamed, A. H., Choudhry, M. W., ... Jneid, H. (Accepted/In press). Outcomes of urgent versus nonurgent transcatheter aortic valve replacement. Catheterization and Cardiovascular Interventions. https://doi.org/10.1002/ccd.28563

Outcomes of urgent versus nonurgent transcatheter aortic valve replacement. / Elbadawi, Ayman; Elgendy, Islam Y.; Mentias, Amgad; Saad, Marwan; Mohamed, Ahmed H.; Choudhry, Muhammad Waqas; Ogunbayo, Gbolahan O.; Gilani, Syed; Jneid, Hani.

In: Catheterization and Cardiovascular Interventions, 01.01.2019.

Research output: Contribution to journalArticle

Elbadawi, Ayman ; Elgendy, Islam Y. ; Mentias, Amgad ; Saad, Marwan ; Mohamed, Ahmed H. ; Choudhry, Muhammad Waqas ; Ogunbayo, Gbolahan O. ; Gilani, Syed ; Jneid, Hani. / Outcomes of urgent versus nonurgent transcatheter aortic valve replacement. In: Catheterization and Cardiovascular Interventions. 2019.
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abstract = "Background: There is a paucity of data regarding the outcomes of transcatheter valve replacement (TAVR) performed in an urgent clinical setting. Methods: The Nationwide Inpatient Sample (NIS) database years 2011–2014 was used to identify hospitalizations for TAVR in the urgent setting. Using propensity score matching, we compared patients who underwent TAVR in nonurgent versus urgent settings. Results: Among 42,154 hospitalizations in which TAVR was performed, 10,114 (24{\%}) underwent urgent TAVR. There was an uptrend in the rate of urgent TAVR procedures (p =.001). The rates of in-hospital mortality among this group did not change during the study period (p =.713). Nonurgent TAVR was associated with lower mortality (odds ratio [OR] = 0.78; 95{\%} confidence interval [CI]: 0.69–0.89, p <.001) compared with urgent TAVR. Nonurgent TAVR was associated with lower incidence of cardiogenic shock (OR = 0.46; 95{\%}CI: 0.40–0.53 p <.001), use of mechanical circulatory support devices (OR = 0.69; 95{\%}CI: 0.59–0.82, p <.001), AKI (OR = 0.60; 95{\%}CI: 0.56–0.64 p <.001), hemodialysis (OR = 0.67; 95{\%}CI: 0.56–0.80 p <.001), major bleeding (OR = 0.94; 95{\%}CI: 0.89–0.99 p =.045) and shorter length of stay (7.08 ± 6.317 vs. 12.39 ± 9.737 days, p <.001). There was no difference in acute stroke (OR = 0.96; 95{\%}CI: 0.81–1.14, p =.636), vascular complications (OR = 1.07; 95{\%}CI: 0.89–1.29, p =.492), and pacemaker insertions (OR = 0.92; 95{\%}CI: 0.84–1.01, p =.067) between both groups. Among those undergoing urgent TAVR, subgroup analysis showed higher mortality in patients ≤80 years (p =.033), women (p <.001), chronic kidney disease (p =.001), heart failure (p <.001), and liver disease (p =.003). Conclusion: In this large nationwide analysis, almost a quarter of TAVR procedures were performed in the urgent settings. Although urgent TAVR was associated with higher mortality and increased complications compared with nonurgent TAVR, the absolute difference in in-hospital mortality was not remarkably higher. Thus, urgent TAVR can be considered as a reasonable approach when indicated.",
keywords = "decompensated aortic stenosis, transcatheter aortic valve replacement, urgent",
author = "Ayman Elbadawi and Elgendy, {Islam Y.} and Amgad Mentias and Marwan Saad and Mohamed, {Ahmed H.} and Choudhry, {Muhammad Waqas} and Ogunbayo, {Gbolahan O.} and Syed Gilani and Hani Jneid",
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T1 - Outcomes of urgent versus nonurgent transcatheter aortic valve replacement

AU - Elbadawi, Ayman

AU - Elgendy, Islam Y.

AU - Mentias, Amgad

AU - Saad, Marwan

AU - Mohamed, Ahmed H.

AU - Choudhry, Muhammad Waqas

AU - Ogunbayo, Gbolahan O.

AU - Gilani, Syed

AU - Jneid, Hani

PY - 2019/1/1

Y1 - 2019/1/1

N2 - Background: There is a paucity of data regarding the outcomes of transcatheter valve replacement (TAVR) performed in an urgent clinical setting. Methods: The Nationwide Inpatient Sample (NIS) database years 2011–2014 was used to identify hospitalizations for TAVR in the urgent setting. Using propensity score matching, we compared patients who underwent TAVR in nonurgent versus urgent settings. Results: Among 42,154 hospitalizations in which TAVR was performed, 10,114 (24%) underwent urgent TAVR. There was an uptrend in the rate of urgent TAVR procedures (p =.001). The rates of in-hospital mortality among this group did not change during the study period (p =.713). Nonurgent TAVR was associated with lower mortality (odds ratio [OR] = 0.78; 95% confidence interval [CI]: 0.69–0.89, p <.001) compared with urgent TAVR. Nonurgent TAVR was associated with lower incidence of cardiogenic shock (OR = 0.46; 95%CI: 0.40–0.53 p <.001), use of mechanical circulatory support devices (OR = 0.69; 95%CI: 0.59–0.82, p <.001), AKI (OR = 0.60; 95%CI: 0.56–0.64 p <.001), hemodialysis (OR = 0.67; 95%CI: 0.56–0.80 p <.001), major bleeding (OR = 0.94; 95%CI: 0.89–0.99 p =.045) and shorter length of stay (7.08 ± 6.317 vs. 12.39 ± 9.737 days, p <.001). There was no difference in acute stroke (OR = 0.96; 95%CI: 0.81–1.14, p =.636), vascular complications (OR = 1.07; 95%CI: 0.89–1.29, p =.492), and pacemaker insertions (OR = 0.92; 95%CI: 0.84–1.01, p =.067) between both groups. Among those undergoing urgent TAVR, subgroup analysis showed higher mortality in patients ≤80 years (p =.033), women (p <.001), chronic kidney disease (p =.001), heart failure (p <.001), and liver disease (p =.003). Conclusion: In this large nationwide analysis, almost a quarter of TAVR procedures were performed in the urgent settings. Although urgent TAVR was associated with higher mortality and increased complications compared with nonurgent TAVR, the absolute difference in in-hospital mortality was not remarkably higher. Thus, urgent TAVR can be considered as a reasonable approach when indicated.

AB - Background: There is a paucity of data regarding the outcomes of transcatheter valve replacement (TAVR) performed in an urgent clinical setting. Methods: The Nationwide Inpatient Sample (NIS) database years 2011–2014 was used to identify hospitalizations for TAVR in the urgent setting. Using propensity score matching, we compared patients who underwent TAVR in nonurgent versus urgent settings. Results: Among 42,154 hospitalizations in which TAVR was performed, 10,114 (24%) underwent urgent TAVR. There was an uptrend in the rate of urgent TAVR procedures (p =.001). The rates of in-hospital mortality among this group did not change during the study period (p =.713). Nonurgent TAVR was associated with lower mortality (odds ratio [OR] = 0.78; 95% confidence interval [CI]: 0.69–0.89, p <.001) compared with urgent TAVR. Nonurgent TAVR was associated with lower incidence of cardiogenic shock (OR = 0.46; 95%CI: 0.40–0.53 p <.001), use of mechanical circulatory support devices (OR = 0.69; 95%CI: 0.59–0.82, p <.001), AKI (OR = 0.60; 95%CI: 0.56–0.64 p <.001), hemodialysis (OR = 0.67; 95%CI: 0.56–0.80 p <.001), major bleeding (OR = 0.94; 95%CI: 0.89–0.99 p =.045) and shorter length of stay (7.08 ± 6.317 vs. 12.39 ± 9.737 days, p <.001). There was no difference in acute stroke (OR = 0.96; 95%CI: 0.81–1.14, p =.636), vascular complications (OR = 1.07; 95%CI: 0.89–1.29, p =.492), and pacemaker insertions (OR = 0.92; 95%CI: 0.84–1.01, p =.067) between both groups. Among those undergoing urgent TAVR, subgroup analysis showed higher mortality in patients ≤80 years (p =.033), women (p <.001), chronic kidney disease (p =.001), heart failure (p <.001), and liver disease (p =.003). Conclusion: In this large nationwide analysis, almost a quarter of TAVR procedures were performed in the urgent settings. Although urgent TAVR was associated with higher mortality and increased complications compared with nonurgent TAVR, the absolute difference in in-hospital mortality was not remarkably higher. Thus, urgent TAVR can be considered as a reasonable approach when indicated.

KW - decompensated aortic stenosis

KW - transcatheter aortic valve replacement

KW - urgent

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