Incidence, predictors and clinical impact of upper gastrointestinal bleeding after transcatheter aortic valve replacement.

IF 5.1 2区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Heart Pub Date : 2025-05-10 DOI:10.1136/heartjnl-2024-325359

Masaaki Nakase, Dominik F Draxler, Daijiro Tomii, Dik Heg, Taishi Okuno, Daryoush Samim, Jonas Lanz, Stefan Stortecky, David Reineke, Stephan Windecker, Thomas Pilgrim

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引用次数: 0

Abstract

Background: Upper gastrointestinal (GI) bleeding following transcatheter aortic valve replacement (TAVR) is common in patients with aortic stenosis due to the combination of acquired type 2A von Willebrand disease and aspirin-based antiplatelet therapy. We aimed to investigate the incidence, predictors and clinical outcomes of late upper GI bleeding in patients undergoing TAVR.

Methods: In a prospective TAVR registry, patients were stratified according to upper GI bleeding within 1 year of discharge.

Results: Among the 3144 eligible patients, 54 (1.7%) experienced upper GI bleeding after discharge. Of these, 40 patients had major or life-threatening bleeding, while 14 had minor bleeding events. The presence of atrial fibrillation or atrial flutter (HR_adjusted 2.98; 95% CI 1.65 to 5.38) and previous upper GI bleeding (HR_adjusted 3.51; 95% CI 1.51 to 8.19) were independent predictors of upper GI bleeding, while the use of proton pump inhibitors at discharge (HR_adjusted 0.49; 95% CI 0.27 to 0.89) and higher haemoglobin levels (1 g/dL increase) (HR_adjusted 0.73; 95% CI 0.62 to 0.87) were protective. Patients who experienced major or life-threatening upper GI bleeding had a higher all-cause (73.7% vs 11.4%, HR 5.84; 95% CI 3.41 to 10.02) and cardiovascular mortality (31.6% vs 7.3%, HR 3.87; 95% CI 1.72 to 8.70) compared with those without upper GI bleeding.

Conclusions: Among patients who underwent TAVR, 1.7% of patients experienced upper GI bleeding within 1 year of discharge. Major or life-threatening upper GI bleeding was associated with an increased risk of all-cause and cardiovascular mortality.

Trial registration number: NCT01368250.

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经导管主动脉瓣置换术后上消化道出血的发生率、预测因素及临床影响。

背景：经导管主动脉瓣置换术（TAVR）后上胃肠道（GI）出血在主动脉瓣狭窄患者中很常见，这是由于获得性2A型血管性血血病和基于阿司匹林的抗血小板治疗联合引起的。我们的目的是调查TAVR患者晚期上消化道出血的发生率、预测因素和临床结局。方法：在前瞻性TAVR登记中，根据出院后1年内的上消化道出血对患者进行分层。结果：在3144例符合条件的患者中，54例（1.7%）在出院后出现上消化道出血。其中，40名患者有严重或危及生命的出血，14名患者有轻微出血事件。房颤或心房扑动的存在(hr调整2.98；95% CI 1.65 - 5.38)和既往上消化道出血(hrr调整3.51；95% CI 1.51 - 8.19)是上消化道出血的独立预测因子，而在出院时使用质子泵抑制剂(hr调整0.49；95% CI 0.27 ~ 0.89)和较高的血红蛋白水平（1 g/dL增加）(hr调整0.73；95% CI 0.62 ~ 0.87)具有保护作用。经历过重大或危及生命的上消化道出血的患者有更高的全因出血(73.7% vs 11.4%, HR 5.84；95% CI 3.41 ~ 10.02)和心血管死亡率(31.6% vs 7.3%, HR 3.87；95% CI 1.72 ~ 8.70)，与没有上消化道出血的患者相比。结论：在接受TAVR的患者中，1.7%的患者在出院后1年内出现上消化道出血。严重或危及生命的上消化道出血与全因死亡和心血管死亡风险增加相关。试验注册号：NCT01368250。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Heart 医学-心血管系统

CiteScore

10.30

自引率

5.30%

发文量

320

审稿时长

3-6 weeks

期刊介绍： Heart is an international peer reviewed journal that keeps cardiologists up to date with important research advances in cardiovascular disease. New scientific developments are highlighted in editorials and put in context with concise review articles. There is one free Editor’s Choice article in each issue, with open access options available to authors for all articles. Education in Heart articles provide a comprehensive, continuously updated, cardiology curriculum.