Is elevation of N-terminal pro-B-type natriuretic peptide at discharge associated with 2-year composite endpoint of all-cause mortality and heart failure hospitalisation after transcatheter aortic valve implantation? Insights from a multicentre prospective OCEAN-TAVI registry in Japan
| Autor: | Motoharu Araki, Minoru Yoshiyama, Hiroshi Ueno, Yusuke Watanabe, Kazuki Mizutani, Mana Nakao, Minoru Tabata, Kensuke Takagi, Shinichi Shirai, Tsukasa Okai, Toshihiko Shibata, Kentaro Hayashida, Akihiro Higashimori, Norio Tada, Masahiko Hara, Takashi Murakami, Futoshi Yamanaka, Keiko Kajio, Masanori Yamamoto, Toru Naganuma |
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| Rok vydání: | 2018 |
| Předmět: |
Male
medicine.medical_specialty medicine.drug_class Cardiovascular Medicine 030204 cardiovascular system & hematology Transcatheter Aortic Valve Replacement 03 medical and health sciences 0302 clinical medicine Japan adult cardiology Internal medicine Natriuretic Peptide Brain medicine Natriuretic peptide Humans Prospective Studies Registries 030212 general & internal medicine Mortality Aged 80 and over Heart Failure business.industry Proportional hazards model Incidence Research valvular heart disease heart failure Incidence (epidemiology) Aortic Valve Stenosis General Medicine Prognosis medicine.disease Patient Discharge Peptide Fragments Hospitalization Stenosis Quartile Heart failure Cardiology Population study Female business hormones hormone substitutes and hormone antagonists Biomarkers |
| Zdroj: | BMJ Open |
| ISSN: | 2044-6055 |
| Popis: | ObjectivesThe aim of this study was to investigate the 2-year prognostic impact of N-terminal pro-B-type natriuretic peptide (NT-proBNP) levels at discharge following transcatheter aortic valve implantation (TAVI).DesignMulticentre prospective observational study.SettingsSeven institutions from multicentre, observational registry of symptomatic patients with severe aortic stenosis who undergo TAVI.ParticipantsWe enrolled 500 consecutive patients who underwent TAVI with measurements of NT-proBNP at discharge between 2013 and 2016. Study patients were stratified into two groups according to survival classification and regression tree (CART) analysis: high versus low NT-proBNP groups.InterventionsThe impact of high NT-proBNP on a 2-year composite endpoint consisting of all-cause mortality and heart failure hospitalisation was evaluated using a multivariable Cox model.ResultsMedian age was 86 years (quartile 82–89), and 24.2% of the study population were men. Median Society of Thoracic Surgeon score was 7.1 (5.1–9.8), and NT-proBNP at discharge was 1381 (653–3136) pg/mL. The composite endpoint incidence was 13.0% (95% CI 9.5% to 16.3%) at 1 year and 22.3% (95% CI 16.1%–27.9%) at 2 years. The survival CART analysis revealed that the NT-proBNP level required to discern the 2-year composite endpoint was 4288 pg/mL. Elevated NT-proBNP had a statistically significant impact on outcomes, with adjusted HR of 2.21 (95% CI 1.21 to 4.04, p=0.010), and with a significant sex difference (Pfor interaction=0.003).ConclusionElevation of NT-proBNP at discharge is associated with higher incidence of the 2-year composite endpoint after TAVI.Trial registration number000020423 |
| Databáze: | OpenAIRE |
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