PMID- 30227961
OWN - NLM
STAT- MEDLINE
DCOM- 20190829
LR  - 20190829
IS  - 1879-1913 (Electronic)
IS  - 0002-9149 (Linking)
VI  - 122
IP  - 10
DP  - 2018 Nov 15
TI  - Comparison of Early and Long-Term Outcomes After Transcatheter Aortic Valve 
      Implantation in Patients with New York Heart Association Functional Class IV to 
      those in Class III and Less.
PG  - 1718-1726
LID - S0002-9149(18)31635-7 [pii]
LID - 10.1016/j.amjcard.2018.08.006 [doi]
AB  - Our aim was to investigate the impact of a baseline New York Heart Association 
      (NYHA) class IV on clinical outcomes of a large real-world population who 
      underwent transcatheter aortic valve implantation (TAVI). The primary end points 
      were all-cause mortality, cardiovascular mortality, and re-hospitalization, 
      evaluated at the longest available follow-up and by means of a 3-month landmark 
      analysis. The secondary end points were: change in NYHA class, left ventricular 
      ejection fraction, pulmonary pressure and mitral regurgitation. Out of 2,467 
      patients, 271 (11%) had a NYHA functional class IV at the admission. The latter 
      had higher Society of Thoracic Surgeons (STS) score (9.2% vs 5.5%; p < 0.001) 
      compared to NYHA </= III patients, owing to more comorbidities (prior myocardial 
      infarction, severe long-term kidney disease, atrial fibrillation, left 
      ventricular dysfunction, significant mitral regurgitation, pulmonary 
      hypertension). Device success was similar between the two groups (93.7% vs 94.5%; 
      p = 0.583). At a median follow-up of 15 months (interquartile range 4 to 36 
      months) a lower freedom from primary end points was observed among NYHA IV versus 
      NYHA </= III group (survival from all-cause death: 52% vs 58.4%; p = 0.002; 
      survival from cardiovascular death: 72.5% vs 76.5%; p = 0.091; freedom from 
      re-hospitalization: 81.5% vs 85.4%; p = 0.038). However, after adjustment for 
      baseline imbalance, NYHA IV did not influence the relative risk of long-term 
      primary end points. A 3-month landmark analysis showed that NYHA IV independently 
      predicted 3-month all-cause and cardiovascular mortality (hazard ratio: 1.77; 95% 
      CI [1.10 to 2.83]; p = 0.018 and hazard ratio: 1.64; 95% CI [1.03 to 2.59]; 
      p = 0.036, respectively). Instead, after 3-month follow-up NYHA IV did not affect 
      the risk of primary end points. A significant improvement of the secondary end 
      points was noted in both NYHA IV and NYHA </=</= III groups. In conclusion, the 
      presence of NYHA class IV in TAVI candidates was associated to a significant 
      increased risk of mortality within 3 months. Patients with baseline NYHA IV who 
      survived at 3 months had a long-term outcome comparable to that of other 
      subjects. Left ventricular systolic function, pulmonary pressure, and mitral 
      insufficiency significantly improved after TAVI regardless of baseline NYHA class 
      IV.
CI  - Copyright (c) 2018. Published by Elsevier Inc.
FAU - Adamo, Marianna
AU  - Adamo M
AD  - Catheterization Laboratory, Cardiothoracic Department, Spedali Civili Brescia, 
      Brescia, Italy. Electronic address: mariannaadamo@hotmail.com.
FAU - Fiorina, Claudia
AU  - Fiorina C
AD  - Catheterization Laboratory, Cardiothoracic Department, Spedali Civili Brescia, 
      Brescia, Italy.
FAU - Petronio, Anna Sonia
AU  - Petronio AS
AD  - Catheterization Laboratory, Cardiothoracic and Vascular Department, University of 
      Pisa, Pisa, Italy.
FAU - Giannini, Cristina
AU  - Giannini C
AD  - Catheterization Laboratory, Cardiothoracic and Vascular Department, University of 
      Pisa, Pisa, Italy.
FAU - Tamburino, Corrado
AU  - Tamburino C
AD  - Cardio-Thoracic-Vascular Department, Ferrarotto Hospital, University of Catania, 
      Catania, Italy.
FAU - Barbanti, Marco
AU  - Barbanti M
AD  - Cardio-Thoracic-Vascular Department, Ferrarotto Hospital, University of Catania, 
      Catania, Italy.
FAU - Bedogni, Francesco
AU  - Bedogni F
AD  - Coronary Revascularisation Unit, IRCCS Policlinico S. Donato, S. Donato Milanese, 
      Italy.
FAU - Testa, Luca
AU  - Testa L
AD  - Coronary Revascularisation Unit, IRCCS Policlinico S. Donato, S. Donato Milanese, 
      Italy.
FAU - Colombo, Antonio
AU  - Colombo A
AD  - Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy.
FAU - Latib, Azeem
AU  - Latib A
AD  - Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy.
FAU - Bruschi, Giuseppe
AU  - Bruschi G
AD  - "De Gasperis" Cardio Center ASST Niguarda Metropolitan Hospital, Milan, Italy.
FAU - Reimers, Bernhard
AU  - Reimers B
AD  - Department of Cardiovascular Medicine, Humanitas Clinical and Research Center, 
      Rozzano, Milan, Italy.
FAU - Poli, Arnaldo
AU  - Poli A
AD  - Interventional Cardiology Unit, ASST Ovest Milanese, Legnano Hospital, Milan, 
      Italy.
FAU - Nazzaro, Marco Stefano
AU  - Nazzaro MS
AD  - Interventional Cardiology Unit, S. Camillo Forlanini Hospital, Rome, Italy.
FAU - Curello, Salvatore
AU  - Curello S
AD  - Catheterization Laboratory, Cardiothoracic Department, Spedali Civili Brescia, 
      Brescia, Italy.
FAU - Ettori, Federica
AU  - Ettori F
AD  - Catheterization Laboratory, Cardiothoracic Department, Spedali Civili Brescia, 
      Brescia, Italy.
LA  - eng
PT  - Comparative Study
PT  - Journal Article
PT  - Multicenter Study
DEP - 20180821
PL  - United States
TA  - Am J Cardiol
JT  - The American journal of cardiology
JID - 0207277
SB  - IM
MH  - Aged, 80 and over
MH  - Aortic Valve Stenosis/*surgery
MH  - Cause of Death/trends
MH  - Female
MH  - Follow-Up Studies
MH  - Humans
MH  - Incidence
MH  - Italy/epidemiology
MH  - Male
MH  - Postoperative Complications/*classification/diagnosis/physiopathology
MH  - Prospective Studies
MH  - Risk Factors
MH  - Stroke Volume/*physiology
MH  - Survival Rate/trends
MH  - Time Factors
MH  - Transcatheter Aortic Valve Replacement/*adverse effects
MH  - Ventricular Function, Left/*physiology
EDAT- 2018/09/20 06:00
MHDA- 2019/08/30 06:00
CRDT- 2018/09/20 06:00
PHST- 2018/06/09 00:00 [received]
PHST- 2018/08/01 00:00 [revised]
PHST- 2018/08/07 00:00 [accepted]
PHST- 2018/09/20 06:00 [pubmed]
PHST- 2019/08/30 06:00 [medline]
PHST- 2018/09/20 06:00 [entrez]
AID - S0002-9149(18)31635-7 [pii]
AID - 10.1016/j.amjcard.2018.08.006 [doi]
PST - ppublish
SO  - Am J Cardiol. 2018 Nov 15;122(10):1718-1726. doi: 10.1016/j.amjcard.2018.08.006. 
      Epub 2018 Aug 21.