Acessibilidade / Reportar erro

Brasil

Arquivos Brasileiros de Cardiologia

Español English

Brasil

Español English

sumário « anterior atual seguinte »

Sumário

Original Article • Arq. Bras. Cardiol. 117 (5) • Nov 2021 • https://doi.org/10.36660/abc.20190715 copy

C-reactive Protein as a Prognostic Marker of 1-Year Mortality after Transcatheter Aortic Valve Implantation in Aortic Stenosis

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Background:

C-reactive protein (CRP) is an inflammation biomarker that can be a predictor of adverse events in cardiovascular procedures. Its use in the assessment of long-term prognosis of transcatheter aortic valve implantation (TAVI) is still incipient.

Objective:

To evaluate CRP as a prognostic marker in the first year after TAVI in aortic stenosis (AoS).

Methods:

CRP was assessed on the first postoperative week in a retrospective cohort of patients with AoS. Pre- and post- CRP levels were correlated with mortality, and predictors of 1-year mortality were investigated. Multivariate Cox regression was performed to identify independent factors of 1-year mortality.

Results:

This study evaluated 130 patients who underwent TAVI, with median age of 83 years, and 49% of women. High pre-TAVI CRP (> 0.5 mg/dL) was observed in 34.5% of the cases. Peak CRP was 7.0 (5.3-12.1) mg/dL no quarto dia. The rate of 1-year mortality was 14.5% (n = 19), being greater in the groups with high pre-TAVI CRP (68.8% vs 29.1%; p = 0,004) and with peak CRP ≥ 10.0 mg/dL (64.7% vs 30.8%; p = 0,009). Independent predictors of mortality were acute renal failure (ARF) (hazard ratio [HR] = 7.43; 95% confidence interval [95%CI], 2.1-24.7; p = 0,001), high pre-TAVI CRP (HR 4.15; 95%CI, 1.3-12.9; p = 0.01), and large blood transfusion [HR 4,68; 1,3-16,7; p = 0.02].

Conclusions:

High pre-TAVI CRP showed to be an independent predictor of 1-year mortality, as well as the presence of ARF and large blood transfusions.

Keywords:
C-Reactive Protein; Inflammation; Bomarkers; Heart Valve Prosthesis Implantation; Transcatheter Aortic Valve Replacement; Aortic Valve Stenosis

Characteristics	N = 130 n (%)
Age (years) (median)	83.0 (80.0-87.0)
Male sex	67 (51.5)
BMI (median)	25.3 (22.5-29.4)
Clinical presentation
Syncope	38 (29.2)
Angina pectoris	27 (20.8)
HF, NYHA functional class
II	6 (4.8)
III	70 (53.8)
IV	54 (41.5)
Systemic arterial hypertension	94 (72.3)
Diabetes mellitus	48 (36.9)
Coronary arterial disease	70 (53.8)
Previous AMI	15 (11.5)
Previous MRS	30 (23.1)
Previous PCI	42 (32.3)
Previous stroke	7 (5.4)
Peripheral vascular disease	31 (23.8)
COPD	12 (9.2)
Chronic kidney disease^* * Glomerular filtration rate estimated by the Cockcroft-Gault formula < 60 mL/min.	101 (77.7)
Pulmonary arterial hypertension	40 (30.8)
Previous pacemaker	25 (19.2)
STS mortality (%)	8.6 (4.8-19.3)
STS morbidity (%)	34.6 (24.8-63.1)
Anemia	83 (63.8)
Atrial fibrillation	17 (13.1)
LV dysfunction (LVEF < 50%)	33 (25.4)

Characteristics		Non-survivors n = 19	Survivors n = 111	HR (95%CI)	p-value
Age (years)		84 (81-87)	83 (80-87)	-	0,3
Male sex		36.8%	54.1%	-	0,2
BMI (kg/m2)		26.2 (22.6-27.4)	25.2 (22.5-30.1)	-	0,8
NYHA FC IV heart failure		57.9%	38.7%	-	0,1
Diabetes mellitus		42.1%	36.0%	-	0,6
CAD		42.1%	36%	-	0,6
PVD		26.3%	23.4%	-	0,4
COPD		15.8%	8.1%	-	0,3
STS score (%)		17.9 (8.1-30.2)	8.1 (4.7-17.1)	1,03 (1,01-1,06)	0,02
Baseline creatinine (mg/dL)		1.3 (0.8-1.5)	1.1 (0.9-1.3)	-	0,8
LVEF (%)		55 (31-73)	64 (50.5-73.0)	0,98 (0,95-1,00)	0,04
Baseline hemoglobin (mg/dL)		11.2 (10.2-12.9)	12.0 (10.6-13.3)	-	0,4
Nadir hemoglobin (mg/dL)		8.1 (7.4-9.9)	9.8 (8.4-10.9)	0,68 (0,49-0,94)	0,01
Baseline CRP (mg/dL)		1.5 (0.2-2.8)	0,3 (0,2-0,9)	1,19 (1,06-1,34)	<0,0001
Baseline CRP > 0,5 mg/dL		68.8%	29.1%	4,70 (1,63-13,5)	0,004
Peak CRP (mg/dL)		14.3 (6.0-16.2)	7.8 (5.1-11.1)	1,14 (1,06-1,22)	<0,0001
SIRS		47.3%	41.8%	-	0,6
Post-TAVI aortic failure ≥ +2/4		5.3%	5.4%	-	0,99
Major vascular complication		10.5%	4.5%	-	0,2
Bleeding	Major	26.3%	20.7%	-	0,2
Bleeding	Life-threatening	26.3%	4.5%	7,85 (2,62-23,5)	<0,001
Blood transfusion	2 to 3 RBC units	15.8%	5.5%	4,3 (1,20-15,5)	0,02
Blood transfusion	≥ 4 RBC units	26.3%	3.6%	9,4 (3,24-27,2)	<0,001
	Stage I	52.6%	58.2%	8,2 (3,0-23)	<0,001
ARF	Stage II	10.5%	1.8%	14,4 (2,9-72)	0,001
	Stage III	5.3	0.9	14,7 (1,8-123)	0,013
New pacemaker		42.1%	19.8%	2,72 (1.09-6,8)	0,03
NYHA FC III heart failure at 30 days		38.5%	0.0%	66,8 (16-279)	<0,001

Variables in the model	Coefficient	SE Coef	HR	95%CI	p-value
ARF	1,983	0,624	7,43	2,1-24-7	0,001
Baseline CRP > 0.5 mg/dL	1,422	0,577	4,15	1,3-12,9	0,01
Blood transfusion ≥ 4 RBC units	1,543	0,649	4,68	1,3-16,7	0,02

Variables in the model	Coefficient	SE Coef	HR	95%CI	p-value
NYHA FC III heart failure at 30 days	3.3	1.0	27.5	3.8-199	0.001
Male sex	-4.1	1.3	0.02	0.001-0.23	0.002
New pacemaker	2.3	0.8	10.2	2.0-52.3	0.005
Baseline CRP > 0.5 mg/dL	2.1	0.8	8.9	1.6-48.0	0.01

Characteristics		Baseline CRP > 0.5 mg/dL n = 46	Baseline CRP ≤ 0.5 mg/dL n = 84	p-value
Age (years)		84 (80-88)	83 (80-87)	0.3
Male sex		53.7%	48.7%	0.6
BMI (kg/m²)		25.5 (23.3-27.2)	25.3 (22.2-30.1)	0.7
NYHA FC IV heart failure		61.0%	29.5%	0.001
Diabetes mellitus		31.7%	38.5%	0.5
CAD		58.5%	51.3%	0.4
PVD		26.8%	23.1%	0.6
COPD		14.6%	5.1%	0.09
STS score (%)		18.8 (7.7-26.6)	6.9 (4.2-15.3)	0.001
LVEF (%)		60 (44-68)	66 (52-74)	0.3
Baseline creatinine (mg/dL)		1.3 (0.9-1.5)	1.1 (0.9-1,3)	0.06
Baseline hemoglobin (mg/dL)		11.8 (10.0-13.2)	12.1 (10,9-13.3)	0.2
Nadir hemoglobin (mg/dL)		9.3 (8.0-10.9)	9.9 (8.4-10.6)	0.5
Baseline platelets (x10³/mm³)		200 (145- 287)	194 (165-226)	0.4
Nadir platelets (x10³/mm³)		149 (101-192)	125 (102-152)	0.04
Peak CRP (mg/dL)		11.5 (6.5-14.8)	7.2 (4.6-10.3)	0.002
Aortic failure after TAVI ≥ +2/4		2.4%	6.4%	0.6
Bleeding	Major	14.6%	25.6%	0.2
Bleeding	Life-threatening	9.8%	6.4%	0.2
Blood transfusion	2 to 3 RBC units	9.8%	3.8%	0.4
Blood transfusion	≥ 4 RBC units	7.3%	6.4%	0.4
	No ARF	66.7%	80.8%	0.04
ARF	Stage I	25.6%	17.9%
ARF	Stage II	7.7%	0%
	Stage III	0%	1.3%
SIRS		47.5%	42.3%	0.6
New pacemaker		26.8%	21.8%	0.6

Sociedade Brasileira de Cardiologia - SBC Avenida Marechal Câmara, 160, sala: 330, Centro, CEP: 20020-907, (21) 3478-2700 - Rio de Janeiro - RJ - Brazil, Fax: +55 21 3478-2770 - São Paulo - SP - Brazil
E-mail: revista@cardiol.br

Acompanhe os números deste periódico no seu leitor de RSS