Abstract 16140: Systemic Inflammatory Response Syndrome is Associated With Mortality After Transcatheter or Surgical Aortic Valve Replacement With a Greater Impact on Diabetic Patients
Background: An inflammatory response after cardiac surgery is associated with worse clinical outcomes, but recent trials to attenuate it have been neutral. Patients with aortic stenosis (AS) and diabetes have increased mortality after surgical (SAVR) or transcatheter (TAVR) aortic valve replacement, but some data suggest diabetics do better with TAVR. We evaluated the association between systemic inflammatory response syndrome (SIRS) and mortality after TAVR and SAVR and whether diabetes influenced this relationship.
Methods: Patients (n=747) with severe AS treated with TAVR (n=264) or SAVR (n=483) between 1/2008 and 12/2013 were included. SIRS was defined by 4 criteria 12 to 48 hours after AVR: 1) white blood cell (WBC) count <4 or >12; 2) heart rate (HR) >90; 3) temp <36 or >38°C; or 4) respiratory rate >20. We evaluated the relationship between SIRS criteria met and intermediate (6 mo) all-cause death (60 died by 6 mo). Inverse propensity weighting (IPW) was performed on 44 baseline and procedural variables to minimize confounding.
Results: All 4 SIRS criteria were met in 6% of TAVR patients and 11% of SAVR patients (p=0.02); this was associated with increased mortality (IPW adjusted HR 2.77; 95% CI 2.04-3.76; p<0.001). While diabetes (present in 37%) did not differ between groups, the presence of 4 SIRS criteria increased mortality more in diabetic (IPW adjusted HR 4.12; 95% CI 2.69-6.31; p<0.001) than non-diabetic patients (IPW adjusted HR 1.74; 95% CI 1.10-2.73; p=0.02) (interaction p=0.007). The adverse effect of 4 SIRS criteria on mortality was similar after TAVR and SAVR. The criteria for WBC and HR were met more often after SAVR (WBC 55%, HR 80%) than TAVR (WBC 38%, HR 48%) (p<0.001 for each) and each were associated with increased mortality (IPW adjusted HR >2, p<0.001 for each).
Conclusions: SIRS is associated with increased mortality after SAVR or TAVR. It occurs more commonly after SAVR and has a greater impact on mortality in diabetic patients. These findings may have implications for treatment decisions in patients with AS, may help explain differences in outcomes between different AVR approaches, and identify diabetic patients as a high risk sub-group to target in clinical trials with therapies to attenuate SIRS.
Author Disclosures: J.S. Goldstein: None. H.S. Maniar: None. E. Novak: None. M. Nassif: None. A. Tibrewala: None. A.M. Wittenberg: None. C. Lawler: None. A. Zajarias: Consultant/Advisory Board; Modest; Edwards Lifesciences. R.J. Damiano: Research Grant; Modest; Atricure, Medtronic, Edwards Lifesciences. Consultant/Advisory Board; Modest; AtriCure, Medtronic. M.R. Moon: None. J.S. Lawton: None. J.M. Lasala: Consultant/Advisory Board; Modest; Boston Scientific, Direct Flow Medical. B.R. Lindman: Consultant/Advisory Board; Modest; Roche Diagnostics. Research Grant; Significant; Young Investigator Award from Gilead. Other Research Support; Significant; Assay support from Roche Diagnostics and BG-Medicine.
- © 2014 by American Heart Association, Inc.