title: Predictors of clinical outcomes in patients with severe aortic stenosis undergoing TAVI: a multistate analysis.
abstract: BACKGROUND
  Patients with severe aortic stenosis at increased surgical risk continue to experience compromised long-term survival despite successful transcatheter aortic valve implantation. We used time-related pathways in a multistate analysis to identify predictors of adverse long-term outcome in patients who underwent transcatheter aortic valve implantation.
  
  
  RESULTS
  In a cohort of 389 patients with a mean age of 82.4 ± 5.8 years and a STS score of 6.8 ± 5.3 undergoing transcatheter aortic valve implantation between 2007 and 2011, multistate analysis was used to estimate mortality and stroke taking into account intercurrent events including kidney injury and the composite of access site and bleeding complications (ABC). Transapical access emerged as a predictor of kidney injury (hazard ratio [HR], 2.12; 95% confidence interval [CI] 1.00-4.47) and ABC (HR, 1.78; 95% CI, 1.07-2.96), but had no impact on the risk of stroke or death. Body mass index ≤20 kg/m(2) increased the risk of stroke or death (HR, 2.64; 95% CI, 1.25-5.54). Age >80 years (HR, 3.15; 95% CI, 1.11-8.92), body mass index ≤20 kg/m(2) (HR, 4.11; 95% CI, 1.33-12.70), prior stroke (HR, 16.42; 95% CI, 3.63-74.21), and presence of atrial fibrillation at baseline (HR, 4.12; 95% CI, 1.87-9.97) increased the risk of stroke and death after an intercurrent event of ABC.
  
  
  CONCLUSIONS
  A body mass index ≤20 kg/m(2) was identified as a primary predictor of stroke and death after transcatheter aortic valve implantation during long-term follow-up, whereas transapical access emerged as a predictor of kidney injury and ABC. Age >80 years, body mass index ≤20 kg/m(2), prior stroke, and presence of atrial fibrillation at baseline increased the risk of stroke and death after an intercurrent event of ABC.
authors.affiliation: Department of Cardiology, Swiss Cardiovascular Center, Bern University Hospital, Switzerland.
authors.forename: Thomas
authors.initials: T
authors.lastname: Pilgrim
authors.forename: Bindu
authors.initials: B
authors.lastname: Kalesan
authors.forename: Peter
authors.initials: P
authors.lastname: Wenaweser
authors.forename: Christoph
authors.initials: C
authors.lastname: Huber
authors.forename: Stefan
authors.initials: S
authors.lastname: Stortecky
authors.forename: Lutz
authors.initials: L
authors.lastname: Buellesfeld
authors.forename: Ahmed A
authors.initials: AA
authors.lastname: Khattab
authors.forename: Balthasar
authors.initials: B
authors.lastname: Eberle
authors.forename: Steffen
authors.initials: S
authors.lastname: Gloekler
authors.forename: Thomas
authors.initials: T
authors.lastname: Gsponer
authors.forename: Bernhard
authors.initials: B
authors.lastname: Meier
authors.forename: Peter
authors.initials: P
authors.lastname: Jüni
authors.forename: Thierry
authors.initials: T
authors.lastname: Carrel
authors.forename: Stephan
authors.initials: S
authors.lastname: Windecker
mesh_terms: D058186:Acute Kidney Injury / Q000453:epidemiology; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001024:Aortic Valve Stenosis / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D001281:Atrial Fibrillation / Q000453:epidemiology; D015992:Body Mass Index; D006328:Cardiac Catheterization / Q000009:adverse effects / Q000401:mortality; D005260:Female; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D006470:Hemorrhage / Q000209:etiology; D006801:Humans; D008297:Male; D015999:Multivariate Analysis; D016016:Proportional Hazards Models; D012042:Registries; D012307:Risk Factors; D012720:Severity of Illness Index; D020521:Stroke / Q000453:epidemiology; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology