Outcomes of transcatheter aortic-valve implantation in patients receiving chronic systemic corticosteroid treatment

Abstract

The chronic use of systemic corticosteroid (CS) therapy is associated with greater tissue fragility. Data assessing the effects of this treatment on the results of transcatheter aortic-valve implantation (TAVI) are scarce. To describe the impact of chronic use of CS treatment on early and late outcomes after TAVI. All 1299 consecutive patients undergoing TAVI in our institution between October 2006 and November 2018 were included. Their mean age was 81 ± 10 years, 52.4% were male, their median EuroSCORE 2 was 4.7% (2.8–7.5). Among them, 48 (3.7%) received chronic systemic CS treatment at the time of the procedure and were compared to those without CS. Patients with chronic CS therapy tended to be women (60% vs. 47%, P = 0.078) and needed more frequently dialysis (12.5% vs. 2.6%, P = 0.002). All other baseline clinical and echocardiographic characteristics were similar between both groups. No differences were observed in 30-day mortality (6.2% vs. 4.3%, P = 0.46). However, after adjustment, patients in the CS group had more frequent major vascular complications (16.7% vs. 7.4%, hazard ratio (HR) 2.52, 95%Confidence Interval (CI) 1.14–5.9; P = 0.02), major or life-threatening bleedings (22.9% vs. 12.4%, HR 2.02, 95%CI 1.00–4.08; P = 0.05) and tamponades (8.3% vs. 2.4%, HR 4.05, 95%CI 1.35–12.15, P < 0.001) at 30 days than those in the non-CS group. At 1-year, all-cause mortality was significantly higher in CS group than in the non-CS group (37.5% vs. 12.6%, p-log rank < 0.0001). Multivariate analysis confirmed that chronic use of CS was an independent predictor of 1-year all-cause mortality (HR 2.29, 95%CI: 1.16–4.50, P = 0.017) ( Fig. 1 ). Chronic systemic CS treatment was associated with an increase in major or life-threatening bleedings, major vascular complications and tamponades at 30 days and was an independent predictor of 1-year all-cause mortality. This treatment should be taken into account in the risk stratification of TAVI candidates.