Frequency, Timing, and Impact of Access-Site and Non-Access-Site Bleeding on Mortality Among Patients Undergoing Transcatheter Aortic Valve Replacement.

Piccolo, Raffaele; Pilgrim, Thomas; Franzone, Anna; Valgimigli, Marco; Haynes, Alan; Asami, Masahiko; Lanz, Jonas; Räber, Lorenz; Praz, Fabien; Langhammer, Bettina; Roost, Eva; Windecker, Stephan; Stortecky, Stefan (2017). Frequency, Timing, and Impact of Access-Site and Non-Access-Site Bleeding on Mortality Among Patients Undergoing Transcatheter Aortic Valve Replacement. JACC. Cardiovascular Interventions, 10(14), pp. 1436-1446. Elsevier 10.1016/j.jcin.2017.04.034

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OBJECTIVES The aim of this study was to examine the frequency, timing, and association of access-site and non-access-site bleeding with mortality in the setting of transcatheter aortic valve replacement (TAVR) during long-term follow-up. BACKGROUND Bleeding is frequent and associated with impaired prognosis in patients undergoing TAVR. It is currently unknown whether the site of bleeding differentially influences the outcomes of TAVR patients. METHODS In total, 926 consecutive patients undergoing TAVR from 2007 through 2014 were evaluated. Bleeding was assessed according to the Valve Academic Research Consortium 2 criteria. The primary outcome of interest was all-cause mortality up to 5 years of follow-up. RESULTS A total of 285 patients (30.7%) experienced at least 1 (minor, major, or life-threatening) bleeding event up to 5 years. Compared with patients not experiencing bleeding, the adjusted risk for all-cause mortality was significantly increased among patients with access-site (hazard ratio: 1.34; 95% confidence interval: 1.01 to 1.76; p = 0.04) and non-access-site bleeding (hazard ratio: 2.08; 95% confidence interval: 1.60 to 2.71; p < 0.001). However, non-access-site bleeding conferred a significantly higher risk for mortality compared with access-site bleeding (hazard ratio: 1.56; 95% confidence interval: 1.12 to 2.18; p = 0.009). At multivariate analysis, female sex was a significant correlate of access-site bleeding, whereas chronic kidney disease and the Society of Thoracic Surgeons score were significantly associated with non-access-site bleeding. CONCLUSIONS Among patients with severe aortic stenosis undergoing TAVR, access-site and non-access-site bleeding were independently associated with an increased risk for mortality, with the greatest risk related to non-access-site bleeding during long-term follow-up.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of Cardiovascular Disorders (DHGE) > Clinic of Cardiology
04 Faculty of Medicine > Department of Cardiovascular Disorders (DHGE) > Clinic of Cardiovascular Surgery
04 Faculty of Medicine > Pre-clinic Human Medicine > Institute of Social and Preventive Medicine
04 Faculty of Medicine > Pre-clinic Human Medicine > CTU Bern

UniBE Contributor:

Piccolo, Raffaele; Pilgrim, Thomas; Franzone, Anna; Valgimigli, Marco; Haynes, Alan; Asami, Masahiko; Lanz, Jonas; Räber, Lorenz; Praz, Fabien; Langhammer, Bettina; Roost, Eva; Windecker, Stephan and Stortecky, Stefan

Subjects:

600 Technology > 610 Medicine & health
300 Social sciences, sociology & anthropology > 360 Social problems & social services

ISSN:

1876-7605

Publisher:

Elsevier

Language:

English

Submitter:

Beatrice Minder Wyssmann

Date Deposited:

05 Sep 2017 10:30

Last Modified:

25 Jul 2018 02:30

Publisher DOI:

10.1016/j.jcin.2017.04.034

PubMed ID:

28728657

Uncontrolled Keywords:

TAVR access-site bleeding aortic stenosis bleeding non–access-site bleeding

BORIS DOI:

10.7892/boris.102445

URI:

https://boris.unibe.ch/id/eprint/102445

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