title: Prevalence, factors associated with, and prognostic effects of preoperative anemia on short- and long-term mortality in patients undergoing transcatheter aortic valve implantation.
abstract: BACKGROUND
  There is scant information on the prevalence and factors associated with preoperative anemia in patients undergoing transcatheter aortic valve implantation (TAVI) and whether it is associated with mortality. We sought to determine the prevalence and factors associated with preoperative anemia in addition to the prognostic effects of the various levels of preoperative hemoglobin level on mortality in patients undergoing TAVI.
  
  
  RESULTS
  Ten-center observational study encompassing 1696 patients with aortic stenosis who underwent TAVI was conducted. Anemia was defined by the World Health Organization criteria (hemoglobin <12.0 g/dL in women and <13.0 g/dL in men). The prevalence of preoperative anemia was 57%. Patient-related factors associated with preoperative anemia were (descending order of odds ratio [95% confidence interval]) as follows: anemia-related medication (4.90 [3.08-7.80]), history of heart failure (1.77 [1.43-2.20]), male sex (1.69 [1.32-2.16]), mitral regurgitation grade ≥III (1.61 [1.15-2.25]), history of malignancy (1.44 [1.03-2.09]), and peripheral vascular disease (1.33 [1.04-1.70]). The creatinine clearance was inversely associated with preoperative anemia (odds ratio, 0.92 [0.87-0.97]). In multivariable analyses, preoperative anemia was not associated with 30-day mortality (1.72 [0.96-3.12]; P=0.073) but showed the strongest association with 1-year mortality with a hazard ratio (95% confidence interval) of 2.78 (1.60-4.82) in patients with hemoglobin <10 g/dL. Patients with anemia received ≥1 blood transfusion 2× more often, but the indication of transfusion was unrelated to overt bleeding in 60%. Blood transfusion was associated with mortality at 30 days (odds ratio, 1.25 [95% confidence interval, 1.08-3.67]) and during follow-up (hazard ratio, 1.09 [95% confidence interval, 1.03-1.14]).
  
  
  CONCLUSIONS
  Preoperative anemia is prevalent in >50% of patients undergoing TAVI. Various baseline factors were related to anemia, which in turn was associated with 1-year mortality. Patients with anemia received more transfusions but mostly for indications unrelated to overt bleeding, whereas transfusion was independently associated with both early and 1-year mortality. These findings indicate that optimization of baseline factors related to preoperative anemia, in addition to more strict criteria of the use of blood products, may improve outcome after TAVI.
authors.affiliation: From the Department of Cardiology, ThoraxCenter (R.-J.N., N.v.M., R.T.v.D., P.P.d.J.) and Department of Nephrology (T.v.G.), Erasmus Medical Center, Rotterdam, The Netherlands; Department of Medicine II-Cardiology, University Hospital Bonn, Bonn, Germany (J.-M.S., G.N., N.W.); Department of Cardiology, Quebec Heart and Lung Institute, Laval University, Quebec City, Canada (J.R.-C., M.U., E.D.); Department of Cardiology, Bergmannsheil, Ruhr-University Bochum, Bochum, Germany (M.G.); Department of Cardiothoracic Surgery, University Hospital Maastricht, Maastricht, The Netherlands (L.v.G., J.M.); Department of Cardiology, University Hospital Saint-Luc, Brussels, Belgium (J.K., P.A.); Department of Cardiology, University Hospital Antwerp, Antwerp, Belgium (J.B.); Department of Cardiology, Royal Perth Hospital, Perth, Western Australia, Australia (G.Y.); Department of Cardiology, Angiografia de Occidente S.A., Cali, Colombia (A.E.D., S.P., L.M.B.); and Department of Cardiology, Hospital Clínico Universitario de Valladolid, Valladolid, Spain (A.R.-O., I.J.A.-S., J.L.).
authors.forename: Rutger-Jan
authors.initials: RJ
authors.lastname: Nuis
authors.forename: Jan-Malte
authors.initials: JM
authors.lastname: Sinning
authors.forename: Josep
authors.initials: J
authors.lastname: Rodés-Cabau
authors.forename: Michael
authors.initials: M
authors.lastname: Gotzmann
authors.forename: Leen
authors.initials: L
authors.lastname: van Garsse
authors.forename: Joelle
authors.initials: J
authors.lastname: Kefer
authors.forename: Johan
authors.initials: J
authors.lastname: Bosmans
authors.forename: Gerald
authors.initials: G
authors.lastname: Yong
authors.forename: Antonio E
authors.initials: AE
authors.lastname: Dager
authors.forename: Ana
authors.initials: A
authors.lastname: Revilla-Orodea
authors.forename: Marina
authors.initials: M
authors.lastname: Urena
authors.forename: Georg
authors.initials: G
authors.lastname: Nickenig
authors.forename: Nikos
authors.initials: N
authors.lastname: Werner
authors.forename: Jos
authors.initials: J
authors.lastname: Maessen
authors.forename: Parla
authors.initials: P
authors.lastname: Astarci
authors.forename: Sergio
authors.initials: S
authors.lastname: Perez
authors.forename: Luis M
authors.initials: LM
authors.lastname: Benitez
authors.forename: Ignacio J
authors.initials: IJ
authors.lastname: Amat-Santos
authors.forename: Javier
authors.initials: J
authors.lastname: López
authors.forename: Eric
authors.initials: E
authors.lastname: Dumont
authors.forename: Nicolas
authors.initials: N
authors.lastname: van Mieghem
authors.forename: Teun
authors.initials: T
authors.lastname: van Gelder
authors.forename: Ron T
authors.initials: RT
authors.lastname: van Domburg
authors.forename: Peter P
authors.initials: PP
authors.lastname: de Jaegere
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000740:Anemia / Q000150:complications* / Q000453:epidemiology*; D001803:Blood Transfusion; D006328:Cardiac Catheterization / Q000401:mortality*; D005260:Female; D005500:Follow-Up Studies; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000401:mortality*; D006351:Heart Valves / Q000601:surgery*; D006801:Humans; D008297:Male; D057234:Preoperative Period; D015995:Prevalence; D011379:Prognosis; D012189:Retrospective Studies; D012737:Sex Factors; D015996:Survival Rate; D013997:Time Factors
keywords: anemia; blood transfusion; hemoglobin