Transcatheter aortic valve implantation with and without mitral stenosis - A National Readmission Database study.
Cardiovasc Revasc Med
; 65: 1-7, 2024 Aug.
Article
en En
| MEDLINE
| ID: mdl-38548532
ABSTRACT
INTRODUCTION:
Mitral valve stenosis (MS) can be concomitantly present in patients undergoing Transcatheter Aortic Valve Implantation (TAVI). Some studies have reported up to one-fifth of patients who underwent TAVI also have MS. The relationship between mitral stenosis and TAVI has led to concerns regarding increased adverse cardiac outcomes during and after the procedure.METHODS:
The Nationwide Readmission Database (NRD 2016-2019) was utilized to identify TAVI patients with MS with ICD-10-CM codes. The primary outcome was a 30-day readmission rate. Secondary outcomes included predictors of all-cause readmissions, length of stay, and total hospitalization cost. We assessed readmission frequency with a national sample weighed at 30 days following the index TAVI procedure. Unadjusted and adjusted odds ratios were analyzed for in-hospital outcomes using univariate and multivariate logistic regression for study cohorts.RESULTS:
A total of 217,147 patients underwent TAVI procedures during the queried time period of the study. Of these patients, 2140 (0.98 %) had MS. The overall 30-day all-cause readmission rate for the study cohort was 12.4 %. TAVI patients with MS had higher rates of 30-day readmissions (15.8 % vs 12.3 %, aOR 1.22, CI 1.03-1.45, P < 0.01). Additionally, TAVI patients with MS had longer lengths of hospital stay during index admissions (5.7 vs. 4.3 days), along with higher total hospitalization costs ($55,157 vs. $50,239). In contrast, in-hospital mortality during index TAVI admission did not differ significantly between the two groups, although there was a trend toward higher mortality in the MS group (2.1 % vs. 1.5 %). Among the TAVI MS cohort, patients admitted on weekends (aOR 1.11, 95 % CI 1.02-1.22, P = 0.01), admitted to non-metropolitan hospitals (aOR 1.29, 95 % CI 1.11-1.66, P = 0.04) and presence of co-morbidities such as atrial fibrillation (AF)/flutter (aOR 1.24, 95 % CI 1.16-1.32, P < 0.01), chronic obstructive pulmonary disease (COPD) (aOR 1.16, 95 % CI 1.11-1.22, P < 0.01), prior stroke (aOR 1.09, 95 % CI 1.03-1.14, P < 0.01), chronic kidney disease (CKD) ≥3 (aOR 1.16, 95 % CI 1.11-1.22, P < 0.01), end-stage renal disease (ESRD) (aOR 1.75, 95 % CI 1.61-1.90, P < 0.01), and anemia (aOR 1.23, 95 % CI 1.18-1.28, P < 0.01) were associated with increased odds of readmission.CONCLUSION:
Concomitant MS in patients undergoing TAVI is associated with higher readmission rates and total hospital costs. This can contribute significantly to healthcare-related burdens. Further studies are required to evaluate in-hospital outcomes and predictors of readmission in patients undergoing TAVI with the presence of concomitant MS.Palabras clave
Texto completo:
1
Colección:
01-internacional
Base de datos:
MEDLINE
Asunto principal:
Estenosis de la Válvula Aórtica
/
Readmisión del Paciente
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Bases de Datos Factuales
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Costos de Hospital
/
Reemplazo de la Válvula Aórtica Transcatéter
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Tiempo de Internación
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Estenosis de la Válvula Mitral
Límite:
Aged
/
Aged80
/
Female
/
Humans
/
Male
País/Región como asunto:
America do norte
Idioma:
En
Revista:
Cardiovasc Revasc Med
Asunto de la revista:
ANGIOLOGIA
/
CARDIOLOGIA
Año:
2024
Tipo del documento:
Article
Pais de publicación:
Estados Unidos