Abstract 10049: Outcomes, Trends and Predictors of Gastrointestinal Bleeding in Patients Undergoing Transcatheter Aortic Valve Implantation

Abstract

Introduction: Gastrointestinal bleeding remains one of the most common cause of major bleeding in patients undergoing transcatheter aortic valve implantation. Hypothesis: GI bleed is associated with worse outcomes in patients undergoing TAVI Methods: We investigated trends, outcomes and predictors of major bleeding from 2011 to 2018 using the national inpatient sample database. Results: A total of 216,023 weighted hospitalizations for TAVI were included in the analysis. Among the included hospitalizations, 2188 patients had GI bleed (1%) whereas 21,385 (99%) patients did not have GI bleed. Presence of peptic ulcer disease was found to be associated with the highest odds of having a GI bleed with an OR 10.24[95% CI, 7.93-13.22] followed closely by colorectal cancer OR 8.02[CI, 185.40-11.91]. Other comorbidities associated with higher adjusted rates of GI bleed were chronic kidney disease ([OR], 1.28[confidence interval (CI), 1.15-1.42]), congestive heart failure (OR, 201.21[CI, 1.08-1.35]), liver disease (OR, 1.82[CI, 1.52-1.2.18]), end stage renal disease (OR, 212.13[CI, 1.79-2.52]), atrial fibrillation (OR, 1.64[CI, 1.50-.77.]) and lung cancer (OR, 2.68[CI, 221.70-4.24]). Over the study period, mortality in patients with a GI bleed with TAVI decreased from 13.6% in 2011 to 11.50% in 2018 along with a decrease in mortality in TAVI without GI bleed group as well. Patients with GI bleed had increased mortality rates as compared those without GI bleed, (12.1% 10 vs 2.1%, p<0.01). Conclusions: In conclusion, we report that mortality is higher in TAVI patients with a GI bleed. Presence of peptic ulcer disease, colorectal cancer or baseline comorbidities like atrial fibrillation and end stage renal disease are important predictors of this adverse event.