Author + information
- Danny Dvir,
- Philippe Généreux,
- Israel M. Barbash,
- Susheel Kodali,
- Itsik Ben–Dor,
- Mathew Williams,
- Rebecca Torguson,
- Ajay K. Kirtane,
- Salem Badr,
- Saar Minha,
- Rebecca Hahn,
- Lowell F. Satler,
- Craig Smith,
- Augusto D. Pichard,
- Martin B. Leon and
- Ron Waksman
Decline in platelet count (DPC) is associated with poor prognosis in patients undergoing coronary intervention. The purpose of this study was to assess the incidence and impact of DPC in patients undergoing transcatheter aortic valve replacement (TAVR).
Data from 495 consecutive pts undergoing TAVR were pooled from 2 medical centers. The % DPC after the procedure was calculated as 100*(baseline platelet count – nadir platelet count) / baseline platelet count. Patients were divided in 3 groups according to the % of DPC: no/mild 50%. VARC outcomes were reported at 30 days and 1 year.
Among the total cohort, 106 patients had baseline thrombocytopenia (21.4%, platelet <150/microliter) vs. 396 patients after TAVR (80%, p <0.001). Distribution of DPC was: no/mild 15.2%, moderate 59.6%, severe 25.3%. (Table) Patients with severe DPC were treated more commonly via transapical access and had higher rates of major vascular complications and major/life–threatening bleeding. Thirty–day and 1–year death rates were significantly higher in the group with severe DPC than in the other groups. However, landmark analysis revealed that in patients surviving 1 month, those with severe DPC had similar 1–year survival (17.5% vs. 20.8% for no/mild DPC and 13.5% for moderate DPC, p=0.25).
In patients undergoing TAVR, severe post procedurals DPC is common and associated with major vascular and bleeding complications, resulting in increased mortality.
|No/minimal DPC (<25%) (n=75)||Moderate DPC (≥25 and <50%) (n=295)||Severe DPC (≥50%) (n=125)||P|
|Age (years)||83.6 ± 7.8||85.2 ± 7.2||84.2 ± 7.6||0.17|
|STS score (%)||11.4 ± 4.3||11.4 ± 4.4||11.7 ± 4.4||0.83|
|30-day major vascular complication||3.3%||4.2%||23.7%||<0.001|
|30-day major/life-threatening bleeding||3.3%||3.4%||14.8%||0.02|
|30-day major stroke||2.6%||2.6%||5.3%||0.11|
Poster Sessions, Expo North
Monday, March 11, 2013, 9:45 a.m.–10:30 a.m.
Session Title: Structural Heart Disease Intervention
Abstract Category: 49. TCT@ACC–i2: Aortic Valve Disease
Presentation Number: 2114–233
- 2013 American College of Cardiology Foundation