Baseline B-type Natriuretic Peptide Predicts Inpatient Outcomes in Transcatheter Aortic Valve Replacement
Monday, May 20, 2019
Belmont Ballroom 2-3 (The Cosmopolitan of Las Vegas)
Giorgio A Medranda, M.D.
,
NYU Winthrop Hospital, Brooklyn, NY
Rosenblum, Jake Rosenblum, DO
,
NYU Winthrop Hospital, Mineola, NY
Khaled Salhab, M.D.
,
NYU Winthrop Hospital, Mineola, NY
Richard K Schwartz, D.O.
,
NYU Winthrop Hospital, Mineola, NY
Stephen J Green, M.D.
,
NYU Winthrop Hospital, Mineola, NY
Background:
The prognostic value of B-type natriuretic peptide (BNP) has been extensively studied in surgical aortic valve replacement (SAVR). Baseline plasma BNP levels have not been well studied in the intermediate-risk patients undergoing transcatheter aortic valve replacement (TAVR) and studies in high-risk patients have been conflicting. The purpose of this study was to examine the utility of baseline BNP levels in predicting inpatient outcomes following TAVR in intermediate and high-risk patients.
Methods:
This was a retrospective, observational study of 1350 intermediate or high-risk patients who underwent TAVR at our institution from 2012-2018. We collected baseline clinical characteristics as well as baseline BNP levels prior to TAVR. Patients were then dichotomized into two cohorts: cohort 1 included patients whose baseline BNP was <500pg/ml and cohort 2 included patients whose baseline BNP was ≥500pg/ml. Our primary outcomes of interest were hours in the intensive care unit (ICU), post-TAVR length of stay (LOS) and inpatient mortality. Statistical analyses of outcomes were performed using multivariate binary logistic regression.
Results:
Cohort 1 consisted of 957 patients and cohort 2 consisted of 393 patients. Patients with a baseline BNP ≥500pg/mL were 1.36 times more likely (CI 0.565, 0.964, p=0.0257) to have an ICU stay >24 hours. Patients with a baseline BNP ≥500pg/mL were 1.67 times more likely (CI 0.461, 0.777, p=0.0001) to have a post-TAVR LOS >2 days. Patients with a baseline BNP ≥500pg/mL were 2.49 times more likely (CI 0.203, 0.792, p=0.0085) to have inpatient death.
Conclusions:
Using a baseline BNP cutoff of 500pg/ml in intermediate or high-risk patients with severe symptomatic AS undergoing TAVR, our data suggests that BNP can provide a non-invasive, objective tool to help risk stratify this growing patient population. Our study provides evidence that measuring baseline BNP prior to TAVR can help identify which patients who are at risk for prolonged LOS and inpatient death.
