Platelet Reduction after Transcatheter Aortic Valve Implantation: Results from the PORTRAIT Study
Abstract
:1. Introduction
2. Materials and Methods
2.1. Ethical Statement
2.2. Inclusion and Exclusion Criteria
2.3. Definitions and Endpoints
2.4. Statistical Analysis
3. Results
3.1. Study Population
3.2. Changes in Blood Elements after TAVI
3.3. Early Clinical Outcomes after TAVI
4. Discussion
Study Limitations
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Overall Population (n = 632) | SEV (n = 316) | BEV (n = 316) | SMD | |
---|---|---|---|---|
Age (years) | 81.1 ± 6.1 | 81.3 ± 6.1) | 80.9 ± 6.1) | 0.07 |
Female gender | 333 (52.7%) | 171 (54.1%) | 162 (51.3%) | 0.06 |
BMI (kg/m2) | 27.3 ± 4.9 | 27.3 ± 4.9 | 27.3 ± 4.9 | −0.01 |
BSA (m2) | 1.9 ± 0.2 | 1.8 ± 0.2 | 1.9 ± 0.2 | −0.04 |
Hypertension | 596 (94.3%) | 299 (94.6%) | 297 (94.0%) | 0.06 |
Diabetes mellitus type II | 249 (39.4%) | 122 (38.6%) | 127 (40.2%) | −0.04 |
Smoking | 349 (55.2%) | 172 (54.4%) | 177 (56.0%) | −0.04 |
Dyslipidemia | 460 (72.8%) | 230 (72.8%) | 230 (72.8%) | 0.00 |
NYHA class | 0.03 | |||
I | 10 (1.6%) | 5 (1.6%) | 5 (1.6%) | |
II | 97 (15.3%) | 52 (16.5%) | 45 (14.2%) | |
III | 420 (66.5%) | 209 (66.1%) | 211 (66.8%) | |
IV | 105 (16.6%) | 50 (15.8%) | 55 (17.4%) | |
COPD | 128 (20.3%) | 61 (19.3%) | 67 (21.2%) | −0.06 |
Atrial fibrillation | 238 (37.7%) | 116 (36.7%) | 122 (38.6%) | −0.04 |
Prior ischemic stroke | 136 (21.5%) | 84 (26.6%) | 52 (16.5%) | 0.33 |
PAD | 93 (14.7%) | 57 (18.0%) | 36 (11.4%) | 0.29 |
Prior MI | 67 (10.6%) | 33 (10.4%) | 34 (10.8%) | −0.02 |
Prior PCI | 172 (27.2%) | 91 (28.8%) | 81 (25.6%) | 0.09 |
Prior CABG | 112 (17.7%) | 54 (17.1%) | 58 (18.4%) | −0.01 |
Prior valve surgery | 142 (22.5%) | 69 (21.8%) | 73 (23.1%) | −0.04 |
Prior ASA treatment | 23 (3.6%) | 12 (3.8%) | 10 (3.2%) | 0.10 |
Prior DAPT treatment | 24 (3.8%) | 14 (4.4%) | 10 (3.2%) | 0.15 |
Prior LMWH treatment | 21 (3.3%) | 12 (3.8%) | 9 (2.8%) | 0.17 |
Prior warfarin treatment | 17 (2.7%) | 9 (2.8%) | 8 (2.5%) | 0.06 |
Prior DOAC treatment | 17 (2.7%) | 10 (3.2%) | 7 (2.2%) | 0.16 |
EuroSCORE II | 6.2 (3.8–10.6) | 6.2 (4.1–11.8) | 6.1 (3.6–11.0) | −0.09 |
Echocardiographic features | ||||
AV peak gradient (mmHg) | 62.9 ± 30.9 | 63.6 ± 30.9 | 62.2 ± 30.9 | 0.05 |
AV mean gradient (mmHg) | 43.7 ± 14.2 | 43.9 ± 14.7 | 43.6 ± 13.8 | 0.01 |
AVA/BSA (cm2/m2) | 0.40 ± 0.10 | 0.39 ± 0.09 | 0.39 ± 0.10 | 0.01 |
LVEF (%) | 51.5 ± 12.8 | 51.3 ± 12.2 | 51.6 ± 13.5 | −0.02 |
AR mean grade | 0.06 | |||
None | 297 (47.0%) | 143 (45.3%) | 154 (48.7%) | |
Mild | 72 (11.4%) | 38 (12.0%) | 34 (10.8%) | |
Moderate | 263 (41.6%) | 135 (42.7%) | 128 (40.5%) | |
Severe | 0 (0%) | 0 (0%) | 0 (0%) | |
sPAP (mmHg) | 53.4 ± 16.1 | 52.9 ± 16.3 | 53.9 ± 15.9 | −0.06 |
Status | −0.08 | |||
Elective | 586 (92.7%) | 297 (94.0%) | 289 (91.5%) | |
Urgent | 45 (7.1%) | 18 (5.7%) | 27 (8.5%) | |
Emergent | 1 (0.2%) | 1 (0.3%) | 0 (0%) | |
Access | 0.06 | |||
Femoral artery | 474 (75.0%) | 233 (73.7%) | 241 (76.3%) | |
LV apex | 157 (24.8%) | 83 (26.3%) | 74 (23.4%) | |
Ascending aorta | 1 (0.2%) | 0 (0%) | 1 (0.3%) | |
Carotid artery | 0 (0%) | 0 (0%) | 0 (0%) | |
Access conversion | 6 (0.9%) | 3 (0.9%) | 3 (0.9%) | 0.00 |
TIME | Overall Population (n = 632) | SEV (n = 316) | BEV (n = 316) | p-Value |
---|---|---|---|---|
Platelet count (×103 µL) | ||||
Baseline | 211 (171–254) | 208 (169–252) | 213 (177–261) | 0.189 |
Day 0 | 175 (137–206) | 176 (147–212) | 164 (130–199) | 0.216 |
Day 1 | 166 (137–205) | 164 (138–208) | 169 (137–202) | 0.912 |
Day 2 | 149 (120–185) | 150 (124–189) | 149 (112–183) | 0.330 |
Day 3 | 147 (114–186) | 149 (120–186) | 146 (108–181) | 0.142 |
Day 4 | 155 (122–200) | 162 (128–197) | 147 (118–200) | 0.203 |
Day 5 | 166 (126–212) | 166 (136–207) | 165 (122–218) | 0.634 |
Discharge | 227 (169–283) | 234 (174–290) | 217 (166–278) | 0.196 |
Hemoglobin (g/dL) | ||||
Baseline | 12.3 (11.0–13.4) | 12.3 (11.0–13.4) | 12.2 (11.0–13.4) | 0.945 |
Day 0 | 10.9 (9.9–12.1) | 11.1 (10.0–12.1) | 10.8 (9.9–12.2) | 0.614 |
Day 1 | 10.4 (9.3–11.5) | 10.5 (9.43–11.4) | 10.4 (9.3–11.6) | 0.810 |
Day 2 | 10.1 (9.1–11.3) | 10.2 (9.1–11.3) | 10.1 (9.1–11.2) | 0.591 |
Day 3 | 9.9 (8.9–10.8) | 10.1 (9.1–11.4) | 9.9 (9.1–11.1) | 0.147 |
Day 4 | 9.8 (9.0–11.1) | 9.9 (9.0–11.2) | 9.9 (9.0–11.2) | 0.561 |
Day 5 | 9.5 (8.8–11.1) | 10.1 (9.0–11.3) | 10.0 (9.0–11.0) | 0.124 |
Discharge | 10.8 (9.67–11.7) | 10.5 (9.5–11.7) | 10.6 (9.5–11.7) | 0.143 |
Red blood cells (×1,000,000/µL) | ||||
Baseline | 4.2 (3.8–4.6) | 4.2 (3.8–4.6) | 4.1 (3.7–4.5) | 0.677 |
Day 0 | 3.7 (3.3–4.1) | 3.8 (3.3–4.1) | 3.7 (3.3–4.1) | 0.638 |
Day 1 | 3.5 (3.2–3.9) | 3.5 (3.1–3.9) | 3.5 (3.2–3.9) | 0.969 |
Day 2 | 3.5 (3.1–3.9) | 3.4 (3.1–3.7) | 3.4 (3.1–3.9) | 0.623 |
Day 3 | 3.4 (3.1–3.8) | 3.4 (3.1–3.8) | 3.4 (3.1–3.8) | 0.095 |
Day 4 | 3.4 (3.1–3.8) | 3.4 (3.1–3.8) | 3.4 (3.1–3.8) | 0.335 |
Day 5 | 3.3 (3.1–3.7) | 3.3 (3.0–3.8) | 3.4 (3.1–3.7) | 0.199 |
Discharge | 3.6 (3.3–4.0) | 3.6 (3.3–4.0) | 3.6 (3.3–4.1) | 0.493 |
White Blood cells (×103 µL) | ||||
Baseline | 7.0 (5.8–8.4) | 7.0 (5.8–8.2) | 6.9 (5.8–8.7) | 0.494 |
Day 0 | 8.5 (6.7–10.8) | 8.5 (6.7–10.7) | 8.6 (6.5–11.50) | 0.503 |
Day 1 | 9.3 (7.7–11.5) | 9.8 (7.9–12.3) | 8.8 (7.4–10.9) | <0.001 |
Day 2 | 9.0 (7.3–11.4) | 9.5 (7.6–12.1) | 8.7 (7.2–10.3) | <0.001 |
Day 3 | 8.1 (6.6–10.1) | 8.6 (6.8–10.5) | 7.7 (6.4–9.4) | 0.022 |
Day 4 | 7.7 (6.2–9.9) | 8.0 (6.7–10.1) | 7.5 (5.9–9.5) | 0.188 |
Day 5 | 7.5 (6.2–9.6) | 7.7 (6.0–9.7) | 7.2 (5.8–9.0) | 0.772 |
Discharge | 7.2 (6.0–8.9) | 7.3 (6.1–8.9) | 7.1 (5.8–9.1) | 0.192 |
Overall Population (n = 632) | SEV (n = 316) | BEV (n = 316) | p-Value | |
---|---|---|---|---|
RBC transfusions | 0.138 | |||
0 | 495 (78.3%) | 256 (81.0%) | 239 (75.6%) | |
1 | 38 (6.0%) | 9 (2.8%) | 29 (9.2%) | |
2 | 54 (8.5%) | 28 (8.9%) | 26 (8.2%) | |
>2 | 45 (7.2%) | 23 (7.2%) | 22 (6.8%) | |
Echocardiographic features | ||||
AV peak gradient (mmHg) | 21.6 ± 10.3 | 20.2 ± 10.7 | 23.7 ± 9.9 | 0.274 |
AV mean gradient (mmHg) | 11.1 ± 5.5 | 10.1 ± 5.8 | 12.2 ± 5.3 | 0.662 |
LVEF (%) | 55.4 ± 11.9 | 57.3 ± 11.6 | 53.9 ± 12.3 | 0.265 |
Intraprosthetic regurgitation | 177 (28.1%) | 102 (34.2%) | 75 (24.9%) | 0.065 |
Paravalvular leak | 177 (28.1%) | 75 (24.9%) | 7 (34.2%) | 0.065 |
Moderate or severe | 27 (4.2%) | 8 (2.5%) | 19 (6.4%) | 0.062 |
Antiplatelet/Anticoagulant therapy post-TAVI | ||||
Post ASA treatment | 338 (53.5%) | 149 (47.2%) | 189 (59.8%) | 0.001 |
Post DAPT treatment | 238 (37.7%) | 125 (39.6%) | 113 (35.8%) | 0.384 |
Post LMWH treatment | 12 (1.9%) | 5 (1.6%) | 7 (2.2%) | 0.772 |
Post warfarin treatment | 193 (31%) | 96 (30.4%) | 100 (31.6%) | 0.731 |
Post DOAC treatment | 41 (6.5%) | 25 (7.9%) | 16 (5.0%) | 0.560 |
Early outcomes post-TAVI | ||||
Intracranial bleeding | 1 (0.2%) | 0 (0%) | 1 (0.3%) | 1.000 |
Gastrointestinal bleeding | 4 (0.6%) | 2 (0.6%) | 2 (0.6%) | 1.000 |
Atrial fibrillation | 30 (4.7%) | 16 (6.1%) | 14 (4.4%) | 0.708 |
ICU LoS | 1 (1–2) | 1 (1–2) | 1 (1–2) | 0.211 |
In-hospital LoS | 8 (7–13) | 9 (7–13) | 8 (7–12) | 0.386 |
In-hospital mortality | 40 (6.3%) | 15 (4.7%) | 25 (7.9%) | 0.102 |
Predictive Estimate (95% Conf. Interval) | p-Value | |
---|---|---|
Need for RBC transfusion | 2.611 * (1.907–8.275) | <0.001 |
Need for FFP transfusion | 23.022 * (2.533–209.216) | 0.007 |
Need for PLT transfusion | 21.941 * (4.474–107.612) | 0.001 |
ICU LoS | 1.907 † (1.537– 2.367) | <0.001 |
Prolonged ICU LoS ‡ | 1.851 * (1.147–2.988) | 0.012 |
H LoS | 1.086 † (0.948–1.246) | 0.230 |
Prolonged H LoS § | 1.963 * (1.241–3.105) | 0.004 |
In-hospital mortality | 3.972 * (1.907–8.275) | <0.001 |
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Jiritano, F.; Di Mauro, M.; Serraino, G.F.; Mastroroberto, P.; Caporali, E.; Ferrari, E.; Kowalewski, M.; Scrofani, R.; Patanè, L.; Visicchio, G.; et al. Platelet Reduction after Transcatheter Aortic Valve Implantation: Results from the PORTRAIT Study. J. Clin. Med. 2024, 13, 1579. https://doi.org/10.3390/jcm13061579
Jiritano F, Di Mauro M, Serraino GF, Mastroroberto P, Caporali E, Ferrari E, Kowalewski M, Scrofani R, Patanè L, Visicchio G, et al. Platelet Reduction after Transcatheter Aortic Valve Implantation: Results from the PORTRAIT Study. Journal of Clinical Medicine. 2024; 13(6):1579. https://doi.org/10.3390/jcm13061579
Chicago/Turabian StyleJiritano, Federica, Michele Di Mauro, Giuseppe Filiberto Serraino, Pasquale Mastroroberto, Elena Caporali, Enrico Ferrari, Mariusz Kowalewski, Roberto Scrofani, Leonardo Patanè, Giuseppe Visicchio, and et al. 2024. "Platelet Reduction after Transcatheter Aortic Valve Implantation: Results from the PORTRAIT Study" Journal of Clinical Medicine 13, no. 6: 1579. https://doi.org/10.3390/jcm13061579