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Am J Cardiol. 2017 Mar 1;119(5):770-777. doi: 10.1016/j.amjcard.2016.11.019. Epub 2016 Dec 2.

Prognostic Value of Hypoalbuminemia After Transcatheter Aortic Valve Implantation (from the Japanese Multicenter OCEAN-TAVI Registry).

Author information

1
Department of Cardiology, Toyohashi Heart Center, Toyohashi, Japan. Electronic address: masa-nori@nms.ac.jp.
2
Department of Cardiology, Toyohashi Heart Center, Toyohashi, Japan.
3
Department of Cardiology, Nagoya Heart Center, Nagoya, Japan.
4
Department of Cardiology, Sendai Kousei Hospital, Sendai, Japan.
5
Department of Cardiology, Syonan Kamakura Hospital, Shonan, Japan.
6
Department of Cardiology, New Tokyo Hospital, Chiba, Japan.
7
Department of Cardiology, Saiseikai Yokohama City Eastern Hospital, Yokohama, Japan.
8
Department of Cardiology, Kokura Memorial Hospital, Kokura, Japan.
9
Department of Cardiology, Teikyo University School of Medicine, Tokyo, Japan.
10
Department of Cardiology, Keio University School of Medicine, Tokyo, Japan.

Abstract

Hypoalbuminemia, a frailty criterion, belongs to a group of co-morbidities not captured as a traditional risk factor. We assessed its prognostic value in patients who underwent transcatheter aortic valve implantation (TAVI). The study included 1,215 consecutive patients from the Optimized Catheter Valvular Intervention -TAVI Japanese multicenter registry. Hypoalbuminemia was defined as serum albumin level <3.5 g/dl. Baseline characteristics, procedural outcomes, and all-cause, cardiovascular and noncardiovascular mortality rates after TAVI were compared between patients with albumin level <3.5 g/dl (hypo[h]-ALB group, n = 284) and those with albumin level >3.5 g/dl (nonhypo[nh]-ALB group, n = 931). Several baseline characteristics differed significantly between both groups, including age (85.1 ± 5.1 vs 84.2 ± 4.9 years, p = 0.012), ejection fraction (58.5 ± 14.3% vs 62.9 ± 12.4%, p <0.001), baseline kidney function, or liver disease. The 30-day mortality rate in all patients showed significant differences between the 2 groups (3.9% vs 1.3%, p = 0.005). During a mean follow-up of 330 days, cumulative all-cause, cardiovascular, and noncardiovascular mortality rates were significantly higher in the hALB group than in the nhALB group (log-rank test, p <0.001, p = 0.0021, and p <0.001, respectively). The groups were also analyzed using a propensity matching model for adjusting the baseline differences. The analysis revealed that the poorer prognosis of the hALB group in terms of cumulative all-cause and noncardiovascular mortality was retained (p = 0.038, and p = 0.0068, respectively); however, differences in cardiovascular mortality rates in the 2 groups were attenuated (p = 0.93). In conclusion, hypoalbuminemia was associated with poor prognosis, highlighted by the increase in noncardiovascular mortality. Baseline albumin level could be a useful marker for risk stratification before TAVI.

PMID:
28017301
DOI:
10.1016/j.amjcard.2016.11.019
[Indexed for MEDLINE]

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