Severity of and Recovery From Anemia After Transcatheter Aortic Valve Replacement: An Analysis of the PARTNER Trials and Registries

Abstract

Background: Anemia is associated with increased mortality in patients undergoing transcatheter aortic valve replacement (TAVR); however, data on the effect of the severity of and recovery from anemia on clinical outcomes are limited. This study examined the impact of the severity of and recovery from anemia after TAVR.

Methods: Patients with symptomatic, severe aortic stenosis across all surgical risk groups from the Placement of Aortic Transcatheter Valves (PARTNER) I, II, and III trials and registries who underwent TAVR were analyzed. Baseline anemia was defined as mild (hemoglobin [Hb] level ≥11.0 g/dL and <13.0 g/dL for men and ≥11.0 g/dL and <12.0 g/dL for women) and moderate-to-severe anemia (Hb level <11.0 g/dL). Recovery from anemia was defined as an increase of ≥1 g/dL in the Hb level. Patients with missing Hb information and major bleeding within 30 days were excluded. The association of the severity of and recovery from anemia with clinical outcomes was analyzed using multivariable Cox proportional hazards regression models. The primary outcome was 1-year all-cause mortality.

Results: The Kaplan-Meier estimate for 1-year all-cause mortality was 5.4%, 8.2%, and 14.5% in patients with no, mild, and moderate-to-severe anemia, respectively (P < .001). Recovery from anemia at 30 days occurred in 8.4% (229/2730) of all patients. Compared with those without baseline or 30-day anemia, patients with recovery from anemia had similar 1-year mortality (hazard ratio, 1.02; CI, 0.50-2.08; P = .96), whereas those without recovery from anemia had higher 1-year mortality (hazard ratio, 1.82; CI, 1.17-2.85; P = .009).

Conclusions: In patients undergoing TAVR, moderate-to-severe anemia is independently associated with increased 1-year mortality, and recovery from anemia after TAVR is associated with favorable outcomes. Further efforts are needed to determine whether preprocedural correction of anemia improves post-TAVR outcomes.

Keywords: anemia; anemia recovery; aortic stenosis; transcatheter aortic valve implantation; transfusion.

Graphical abstract

Central Illustration

This figure summarizes the key finding from the study. (A) Cohort formation and identification of patients with anemia from the Placement of Aortic Transcatheter Valves (PARTNER)trials and registries. Time-to-event curves and hazard ratios for 1-year all-cause mortality for the (B) severity of and (C) recovery from anemia. Hb, hemoglobin; HR, hazard ratio; TAVR, transcatheter aortic valve replacement; THV, transcatheter heart valve.

Figure 1

One-year outcomes by severity of anemia. Time-to-event curves for (A) 1-year all-cause mortality, (B) heart failure (HF)-related rehospitalization, and (C) composite of all-cause mortality and HF-related rehospitalization after transcatheter aortic valve replacement in patients with no anemia, mild anemia, and moderate-to-severe anemia. HF-related rehospitalization was defined as rehospitalization that met both the rehospitalization definitions from the trial, , ^,, , and was clinical events committee adjudicated as HF related. The adjusted hazard ratios were compared with those of the no baseline anemia category. HR, hazard ratio.

Figure 2

One-year outcomes by recovery of anemia. Time-to-event curves for (A) 1-year all-cause mortality, (B) heart failure (HF)-related rehospitalization, and (C) composite of all-cause mortality or HF-related rehospitalization after transcatheter aortic valve replacement in patients with no anemia, anemia with recovery, anemia without recovery, and new anemia at 30 days. The results are based on a 30-day landmark analysis. HF-related rehospitalization was defined as rehospitalization that met both the rehospitalization definitions from the trial, , ^,, , and was clinical events committee adjudicated as HF related. The adjusted hazard ratios were compared with those of the no baseline or 30-day anemia category. HR, hazard ratio.