The impact of elevated C-reactive protein levels on long-term outcomes of patients undergoing transcatheter aortic valve replacement.

BACKGROUND

In patients undergoing transcatheter aortic valve replacement (TAVR), elevated pre-procedural C-reactive protein (CRP) levels are frequently observed. Its impact on long-term results of TAVR is unclear. The aim of the study was to investigate the long-term (up to six years) clinical outcomes of TAVR patients with normal compared to elevated CRP levels before TAVR.

METHODS

Consecutive patients undergoing TAVR between August 2012 and January 2023 at a tertiary cardiology facility were included. Patients were divided into two cohorts based on the baseline CRP levels: normal CRP (≤ 5 mg/l) and elevated CRP (>5 mg/l). The cohorts were followed clinically for up to six years after TAVR.

RESULTS

From a total of 1000 TAVR patients (mean age 81 ± 6 years), 268 patients (27 %) were found to have elevated baseline CRP (>5 mg/l). Such patients had significantly more co-morbidities (e.g. chronic obstructive pulmonary disease, atrial fibrillation, heart failure, concomitant valvopathies). They also developed periprocedural infections more frequently (3 % vs. 1 %, p = 0.007) and required more commonly repeat hospitalizations for infections during follow-up (HR 1.97, CI 1.47-2.64, p < 0.001). All-cause mortality and development of valve dysfunction did not significantly differ between patients with elevated and normal baseline CRP levels.

CONCLUSION

Albeit long-term results of TAVR patients with elevated pre-procedural CRP levels seem favorable in terms of survival and development of valve dysfunction, they have an increased risk for periprocedural infections and re-admissions due to infections of any type during the follow-up period.

Informations de copyright

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Déclaration de conflit d'intérêts

Declaration of competing interest S. Toggweiler serves as a consultant and proctor for Medtronic, Boston Scientific, Edwards Lifesciences and Biosensors, as a proctor for Edwards Lifesciences and Abbott Vascular, as a consultant for Medira, Shockwave, Teleflex, atHeart Medical, Veosource, Cardiac Dimensions, ReCor Medical and Polares Medical, has received institutional research grants from Boston Scientific, Fumedica and Novartis and holds equity in Hi-D Imaging. M. Bossard received speaker and consulting fees from Abbott Vascular, Abiomed and SIS Medical. A. Attinger-Toller serves as a consultant for Boston Scientific and received speaker fees from Abbott. M. Wolfrum serves as a proctor and consultant for Biosensors.