Corticosteroid Therapy and Vascular Complications in Patients Undergoing Transcatheter Aortic Valve Replacement: A Meta-analysis With Meta-regression

Abstract

Background: Corticosteroid use is associated with vascular fragility, prolonged wound healing, and infections. Therefore, we sought to compare outcomes between patients with aortic stenosis undergoing transcatheter aortic valve replacement who were using corticosteroids versus those who were not.

Methods: This is a study-level meta-analysis and meta-regression of observational studies. The primary end points of this study were rates of vascular complication (both major and minor), life-threatening bleeding, and 30-day mortality. Secondary end points included acute kidney injury rates, annular rupture, cardiac tamponade, closure device failure, coronary obstruction, periprocedural myocardial infarction, permanent pacemaker implantation, stroke, and specific vascular complications with its complementary therapy.

Results: Across the studies, patients were slightly predominantly female, older, and had a mean left ventricular ejection fraction of more than 50% with an intermediate Logistic EuroScore II. Significant differences were observed in the vascular complication rates between patients on corticosteroids and those who were corticosteroid-free (relative risk, 0.63; 95% CI, 0.35-0.90; P <.001), driven primarily by arterial occlusion, surgery, balloon angioplasty, and stenting (relative risk, 0.63; 95% CI, 0.32-0.93; P <.05). There was no difference in the 30-day mortality. No differences were seen in the length of corticosteroid therapies. For the secondary outcomes, there was an increased risk of annular rupture and cardiac tamponade in patients taking corticosteroids.

Conclusions: In conclusion, this is the first meta-analysis with meta-regression that showed a higher risk for vascular complications and life-threatening bleeding in patients on corticosteroid therapy undergoing transcatheter aortic valve replacement, despite no increase in the risk of 30-day mortality.

Keywords: corticosteroids; heart valve prosthesis implantation; meta-analysis; mortality; transcatheter aortic valve replacement; vascular complications.

Figure 1

Risk of bias summary ROBINS-I tool with traffic lights (A) and summary plot (B).

Figure 2

PreferredReportingItems forSystematicReviews andMeta-analyses(PRISMA)flowchart.

Central Illustration

Left: Random-effects meta-analysis of vascular complications in patients who underwent transcatheter aortic valve replacement using corticosteroids versus those who were not. Right: Random-effects meta-analysis of 30-day mortality associated with transcatheter aortic valve replacement in patients using corticosteroids versus those who were not.

Figure 3

(A) Random-effects meta-analysis of life-threatening bleeding associated with transcatheter aortic valve replacement in patients using corticosteroids versus those who were not. (B) Random-effects meta-regression of life-threatening bleeding versus length of corticosteroid therapy in days. RE, random-effects.

Figure 4

Random-effects meta-regression of vascular complications versus length of corticosteroid therapy in days. RE, random-effects.

Figure 5

Random-effects meta-analysis of the secondary outcomes in patients who underwent transcatheter aortic valve replacement using corticosteroids versus those who were not. AKI, acute kidney injury; MI, myocardial infarction; PPM, permanent pacemaker; PTA, percutaneous transluminal angioplasty; RE, random-effects.