title: Prognostic Value of Hypoalbuminemia After Transcatheter Aortic Valve Implantation (from the Japanese Multicenter OCEAN-TAVI Registry).
abstract: Hypoalbuminemia, a frailty criterion, belongs to a group of co-morbidities not captured as a traditional risk factor. We assessed its prognostic value in patients who underwent transcatheter aortic valve implantation (TAVI). The study included 1,215 consecutive patients from the Optimized Catheter Valvular Intervention -TAVI Japanese multicenter registry. Hypoalbuminemia was defined as serum albumin level <3.5 g/dl. Baseline characteristics, procedural outcomes, and all-cause, cardiovascular and noncardiovascular mortality rates after TAVI were compared between patients with albumin level <3.5 g/dl (hypo[h]-ALB group, n = 284) and those with albumin level >3.5 g/dl (nonhypo[nh]-ALB group, n = 931). Several baseline characteristics differed significantly between both groups, including age (85.1 ± 5.1 vs 84.2 ± 4.9 years, p = 0.012), ejection fraction (58.5 ± 14.3% vs 62.9 ± 12.4%, p <0.001), baseline kidney function, or liver disease. The 30-day mortality rate in all patients showed significant differences between the 2 groups (3.9% vs 1.3%, p = 0.005). During a mean follow-up of 330 days, cumulative all-cause, cardiovascular, and noncardiovascular mortality rates were significantly higher in the hALB group than in the nhALB group (log-rank test, p <0.001, p = 0.0021, and p <0.001, respectively). The groups were also analyzed using a propensity matching model for adjusting the baseline differences. The analysis revealed that the poorer prognosis of the hALB group in terms of cumulative all-cause and noncardiovascular mortality was retained (p = 0.038, and p = 0.0068, respectively); however, differences in cardiovascular mortality rates in the 2 groups were attenuated (p = 0.93). In conclusion, hypoalbuminemia was associated with poor prognosis, highlighted by the increase in noncardiovascular mortality. Baseline albumin level could be a useful marker for risk stratification before TAVI.
authors.affiliation: Department of Cardiology, Toyohashi Heart Center, Toyohashi, Japan. Electronic address: masa-nori@nms.ac.jp.
authors.forename: Masanori
authors.initials: M
authors.lastname: Yamamoto
authors.affiliation: Department of Cardiology, Toyohashi Heart Center, Toyohashi, Japan.
authors.forename: Tetsuro
authors.initials: T
authors.lastname: Shimura
authors.affiliation: Department of Cardiology, Nagoya Heart Center, Nagoya, Japan.
authors.forename: Seiji
authors.initials: S
authors.lastname: Kano
authors.affiliation: Department of Cardiology, Toyohashi Heart Center, Toyohashi, Japan.
authors.forename: Ai
authors.initials: A
authors.lastname: Kagase
authors.affiliation: Department of Cardiology, Toyohashi Heart Center, Toyohashi, Japan.
authors.forename: Atsuko
authors.initials: A
authors.lastname: Kodama
authors.affiliation: Department of Cardiology, Toyohashi Heart Center, Toyohashi, Japan.
authors.forename: Mitsuru
authors.initials: M
authors.lastname: Sago
authors.affiliation: Department of Cardiology, Toyohashi Heart Center, Toyohashi, Japan.
authors.forename: Tatsuya
authors.initials: T
authors.lastname: Tsunaki
authors.affiliation: Department of Cardiology, Nagoya Heart Center, Nagoya, Japan.
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Koyama
authors.affiliation: Department of Cardiology, Sendai Kousei Hospital, Sendai, Japan.
authors.forename: Norio
authors.initials: N
authors.lastname: Tada
authors.affiliation: Department of Cardiology, Syonan Kamakura Hospital, Shonan, Japan.
authors.forename: Futoshi
authors.initials: F
authors.lastname: Yamanaka
authors.affiliation: Department of Cardiology, New Tokyo Hospital, Chiba, Japan.
authors.forename: Toru
authors.initials: T
authors.lastname: Naganuma
authors.affiliation: Department of Cardiology, Saiseikai Yokohama City Eastern Hospital, Yokohama, Japan.
authors.forename: Motoharu
authors.initials: M
authors.lastname: Araki
authors.affiliation: Department of Cardiology, Kokura Memorial Hospital, Kokura, Japan.
authors.forename: Shinichi
authors.initials: S
authors.lastname: Shirai
authors.affiliation: Department of Cardiology, Teikyo University School of Medicine, Tokyo, Japan.
authors.forename: Yusuke
authors.initials: Y
authors.lastname: Watanabe
authors.affiliation: Department of Cardiology, Keio University School of Medicine, Tokyo, Japan.
authors.forename: Kentaro
authors.initials: K
authors.lastname: Hayashida
mesh_terms: D058186:Acute Kidney Injury / Q000453:epidemiology; D000368:Aged; D000369:Aged, 80 and over; D001024:Aortic Valve Stenosis / Q000453:epidemiology / Q000601:surgery*; D002305:Cardiac Tamponade / Q000453:epidemiology; D002318:Cardiovascular Diseases / Q000401:mortality; D016022:Case-Control Studies; D002423:Cause of Death; D015897:Comorbidity; D005260:Female; D006470:Hemorrhage / Q000453:epidemiology; D006801:Humans; D034141:Hypoalbuminemia / Q000453:epidemiology*; D007362:Intensive Care Units; D007564:Japan / Q000453:epidemiology; D007902:Length of Stay; D016015:Logistic Models; D008297:Male; D009026:Mortality; D015999:Multivariate Analysis; D011183:Postoperative Complications / Q000453:epidemiology*; D011379:Prognosis; D057216:Propensity Score; D016016:Proportional Hazards Models; D012042:Registries; D012307:Risk Factors; D012720:Severity of Illness Index; D065467:Transcatheter Aortic Valve Replacement; D016896:Treatment Outcome