Is elevation of N-terminal pro-B-type natriuretic peptide at discharge associated with 2-year composite endpoint of all-cause mortality and heart failure hospitalisation after transcatheter aortic valve implantation? Insights from a multicentre prospective OCEAN-TAVI registry in Japan.
BMJ Open
; 8(8): e021468, 2018 08 17.
Article
en En
| MEDLINE
| ID: mdl-30121598
ABSTRACT
OBJECTIVES:
The aim of this study was to investigate the 2-year prognostic impact of N-terminal pro-B-type natriuretic peptide (NT-proBNP) levels at discharge following transcatheter aortic valve implantation (TAVI).DESIGN:
Multicentre prospective observational study. SETTINGS Seven institutions from multicentre, observational registry of symptomatic patients with severe aortic stenosis who undergo TAVI.PARTICIPANTS:
We enrolled 500 consecutive patients who underwent TAVI with measurements of NT-proBNP at discharge between 2013 and 2016. Study patients were stratified into two groups according to survival classification and regression tree (CART)analysis:
high versus low NT-proBNP groups.INTERVENTIONS:
The impact of high NT-proBNP on a 2-year composite endpoint consisting of all-cause mortality and heart failure hospitalisation was evaluated using a multivariable Cox model.RESULTS:
Median age was 86 years (quartile 82-89), and 24.2% of the study population were men. Median Society of Thoracic Surgeon score was 7.1 (5.1-9.8), and NT-proBNP at discharge was 1381 (653-3136) pg/mL. The composite endpoint incidence was 13.0% (95% CI 9.5% to 16.3%) at 1 year and 22.3% (95% CI 16.1%-27.9%) at 2 years. The survival CART analysis revealed that the NT-proBNP level required to discern the 2-year composite endpoint was 4288 pg/mL. Elevated NT-proBNP had a statistically significant impact on outcomes, with adjusted HR of 2.21 (95% CI 1.21 to 4.04, p=0.010), and with a significant sex difference (P for interaction=0.003).CONCLUSION:
Elevation of NT-proBNP at discharge is associated with higher incidence of the 2-year composite endpoint after TAVI. TRIAL REGISTRATION NUMBER 000020423.Palabras clave
Texto completo:
1
Colección:
01-internacional
Base de datos:
MEDLINE
Asunto principal:
Fragmentos de Péptidos
/
Mortalidad
/
Péptido Natriurético Encefálico
/
Reemplazo de la Válvula Aórtica Transcatéter
/
Insuficiencia Cardíaca
/
Hospitalización
Tipo de estudio:
Clinical_trials
/
Incidence_studies
/
Observational_studies
/
Prognostic_studies
/
Risk_factors_studies
Límite:
Aged80
/
Female
/
Humans
/
Male
País/Región como asunto:
Asia
Idioma:
En
Revista:
BMJ Open
Año:
2018
Tipo del documento:
Article
País de afiliación:
Japón