Abstract 13839: Systemic Inflammatory Response Syndrome Predicts Increased Mortality in Patients After Transcatheter Aortic Valve Implantation
Objective: To elucidate the influence of a systemic inflammatory response syndrome (SIRS) on outcome after transcatheter aortic valve implantation (TAVI).
Background: The outcome of patients in need of surgical or interventional therapy is unfavorably influenced by severe systemic inflammation reactions.
Methods: 138 consecutive TAVI patients were included. Hemodynamic parameters were assessed before and 1h, 4h, 24h after the procedure by continuous pulse contour analysis. Proinflammatory cytokines [Interleukin-6 (IL-6), Interleukin-8 (IL-8)] and acute phase reactants [C-reactive protein (CRP), procalcitonin (PCT)] were meas-ured at baseline and 1h, 4h, 24h, 48h, 72h, and 7 days after TAVI.
Results: Recruited patients were at high risk as reflected by a mean logistic EuroSCORE of 30.3 ± 18.0%. 56 of 138 patients developed a SIRS. The incidence of SIRS was increased in patients with major vascular complications (17% vs. 3%; P=0.014) or acute kidney injury (AKI) (43% vs. 8%; P<0.001). Patients with SIRS had a significantly increased 1-year mortality rate (Hazard ratio 4.3, 95%-confidence interval: 2.2-8.5, P<0.001) after TAVI. Patients who died during follow-up of 1 year had significantly increased IL-8 (P=0.01) and PCT levels (P<0.001). Furthermore, the development of AKI, which in turn predicted poor outcome (1-year mortality: 59%; P<0.001), was also preceded by a significant increase of IL-6 (P=0.004), IL-8 (P=0.04), CRP (P=0.008), and PCT levels (P<0.001).
Conclusions: Post-procedural occurrence of SIRS is a strong predictor of 1-year mortality after TAVI. Our results further suggest that SIRS might play a pivotal role in the pathogenesis of AKI after TAVI.
- © 2011 by American Heart Association, Inc.