RESUMEN

BACKGROUND: Inflammation following transcatheter aortic valve implantation (TAVI) is associated with an increased risk of adverse outcomes. The aim of this study was to compare the inflammatory response between low radial force valves (Acurate neo2, Boston Scientific) and high radial force valves (Evolut R/Pro, Medtronic; SAPIEN Edwards Lifesciences; and Myval, Meril valves). METHODS: We conducted a retrospective study of patients with severe aortic stenosis treated with TAVI between 2021 and 2022. The primary endpoint was the difference in the inflammatory response between low radial force valves and high radial force valves, measured as the difference between post-procedural and pre-procedural high-sensitivity C-reactive protein levels (hsCRP delta). RESULTS: A total of 114 patients were included, of which 65 patients (57%) received a low radial force valve. The hsCRP delta was lower in the low radial force valve group compared to the high radial force valve group (8.7 [2.1-15.6] mg/L vs. 18.8 mg/dL [6.4-19] mg/L; P=0.003), due to a lower post-implantation hsCRP (8.9 [5.45-19.6] mg/L vs. 15.8 [9.8-27.3] mg/L; P=0.013). The incidence of new left bundle branch block (LBBB) after TAVI was lower in the low radial force valve group compared to the high radial force valve group (11 [17%] vs. 18 [37%]; P=0.020). CONCLUSIONS: Low radial force TAVI prostheses were associated with a lower inflammatory response, and a lower incidence of new LBBB compared to the radial force valve group, suggesting that inflammation may contribute to the increased risk of conduction disturbances.

Asunto(s)

Estenosis de la Válvula Aórtica , Proteína C-Reactiva , Prótesis Valvulares Cardíacas , Inflamación , Índice de Severidad de la Enfermedad , Reemplazo de la Válvula Aórtica Transcatéter , Humanos , Reemplazo de la Válvula Aórtica Transcatéter/efectos adversos , Estenosis de la Válvula Aórtica/cirugía , Masculino , Femenino , Estudios Retrospectivos , Anciano de 80 o más Años , Inflamación/etiología , Proteína C-Reactiva/análisis , Proteína C-Reactiva/metabolismo , Anciano , Prótesis Valvulares Cardíacas/efectos adversos , Diseño de Prótesis , Resultado del Tratamiento

RESUMEN

RESUMEN Introducción: El sangrado mayor es la complicación más importante del tratamiento antitrombótico en el síndrome coronario agudo (SCA), y se asocia a mayor mortalidad. Evaluar el riesgo de sangrado es un desafío. La utilidad del Orbit Bleeding score (ORBIT) para evaluar el riesgo de sangrado en SCA ha sido poco estudiada. Objetivo: Evaluar al ORBIT como predictor de sangrado mayor en pacientes internados por SCA en los que se decide la anticoagulación como parte de la estrategia antitrombótica. Materiales y métodos: Se incluyeron en forma retrospectiva pacientes internados en dos unidades coronarias con diagnóstico de SCA que recibieron anticoagulación como parte de la terapia antitrombótica. A todos se les calcularon los scores CRUSADE, ACTION-GWTG y ORBIT con los datos clínicos del ingreso. Se analizo el punto primario de sangrado mayor, definido como una clasificación de BARC 3 o 5. Resultados: Se incluyeron 762 pacientes. El sangrado mayor se presentó en el 3.4%. En el análisis univariado los tres scores fueron predictores de sangrado mayor, mientras que en el multivariado sólo el ORBIT fue predictor independiente de sangrado mayor, con OR 2,46, IC95% 1,61-3,97, p <0,001. El área bajo la curva ROC fue de 0,70, 0,68 y 0,80 para los scores ACTIONGWTG, CRUSADE y ORBIT, respectivamente. El ORBIT presento una mayor área bajo la curva que el CRUSADE (p = 0,03) sin diferencias significativas con el ACTION-GWTG (p = 0,06) Conclusiones: El ORBIT fue el único predictor independiente de sangrado mayor, con una mejor capacidad de discriminación que el CRUSADE, y tendencia a mejor capacidad que el ACTION-GWTG.

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ABSTRACT Background: Major bleeding is the most important complication of antithrombotic treatment in acute coronary syndrome (ACS) and is associated with higher mortality. Assessing the risk of bleeding is a challenge. The usefulness of the Orbit Bleeding Score (ORBIT) to assess the risk of bleeding in ACS has been scarcely studied. Objective: The aim of this study was to evaluate the ORBIT score as a predictor of major bleeding in patients hospitalized for ACS in whom anticoagulation is decided as part of the antithrombotic strategy. Methods: Patients admitted to two coronary care units with diagnosis of ACS who received anticoagulation as part of the antithrombotic therapy were retrospectively included in the study. The CRUSADE, ACTION-GWTG and ORBIT scores were calculated using the admission clinical data. The primary endpoint was major bleeding, defined as BARC 3 or 5 classification. Results: The study included 762 patients. Major bleeding occurred in 3.4% of cases. In the univariate analysis, the three scores were predictors of major bleeding, while in the multivariate analysis only the ORBIT score was an independent predictor of major bleeding (OR: 2.46, 95% CI 1.61-3.97, p <0.001). The area under the ROC curve was 0.70, 0.68 and 0.80 for the ACTION-GWTG, CRUSADE and ORBIT scores, respectively. The ORBIT score presented a higher area under the curve than the CRUSADE score (p=0.03) but without significant difference with the ACTION-GWTG score (p=0.06) Conclusions: The ORBIT score was the only independent predictor of major bleeding, presenting a better discrimination capacity than the CRUSADE score and a tendency to better capacity than the ACTION-GWTG score.