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Predictive value of preprocedural procalcitonin for short- and long-term mortality after transfemoral transcatheter aortic valve implantation

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Abstract

Current risk scores used for patients undergoing transcatheter aortic valve implantation (TAVI) do not reliably predict adverse events after TAVI. Procalcitonin (PCT) is associated with increased atherosclerotic burden and adverse outcomes in patients with cardiovascular disease. The aim of our study is to assess the predictive value of preprocedural serum PCT levels in comparison with established risk scores in TAVI patients. A total of 243 patients undergoing transfemoral TAVI at our institution were included prospectively in the study and 230 of these patients participated in the follow-up 1 year after TAVI. The primary endpoints were mortality at 30 days and 1 year. Multivariable analysis revealed that preprocedural PCT was the only independent predictor of 30-day mortality (HR 2.84; 95% CI 1.59–5.06; p < 0.001) and 1-year mortality (HR 1.90; 95% CI 1.17–3.11; p = 0.01), whereas high-sensitivity C-reactive protein showed no association with procedural outcomes. The results of ROC analysis showed good predictive power of PCT for both outcomes (AUC 0.75; p = 0.0003 for 30-day mortality and AUC 0.71; p < 0.0001 for 1-year mortality). An optimal cut-off value for PCT of 0.06 ng/ml for short- and long-term mortality was determined with the Youden index. A significantly higher mortality rate was observed in the high-PCT group (≥ 0.06 ng/ml) based on Kaplan–Meier analysis (log rank = 12.1; p = 0.001 at 30 days and log rank = 14.2; p = 0.0002 at 1 year). Patients in the high-PCT group also had a considerably worse clinical pro6file. In conclusion, preprocedural PCT is an independent predictor of 30-day and 1-year mortality after TAVI. In particular, a cut-off value of 0.06 ng/ml discriminates patients at higher risk of mortality within 30 days and 1 year of TAVI.

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Authors and Affiliations

  1. Department of Cardiology and Angiology, University of Giessen, Klinikstr. 33, 35392, Giessen, Germany

    Stanislav Keranov, Won-Keun Kim, Matthias Renker, Till Keller, Oliver Dörr, Holger M. Nef, Christian W. Hamm & Christoph Liebetrau

  2. Department of Cardiology, Kerckhoff Heart and Thorax Center, Bad Nauheim, Germany

    Won-Keun Kim, Oliver Dörr, Holger M. Nef, Christian W. Hamm & Christoph Liebetrau

  3. Department of Cardiac Surgery, Kerckhoff Heart and Thorax Center, Bad Nauheim, Germany

    Mani Arsalan, Matthias Renker & Thomas Walther

  4. DZHK (German Centre for Cardiovascular Research), Partner Site RheinMain, Frankfurt am Main, Germany

    Stanislav Keranov, Won-Keun Kim, Mani Arsalan, Till Keller, Oliver Dörr, Holger M. Nef, Christian W. Hamm & Christoph Liebetrau

  5. Department of Cardiology, Sana Klinikum Offenbach, Offenbach, Germany

    Timm Bauer

  6. Department of Internal Medicine, St. Johannes Hospital, Dortmund, Germany

    Luise Gaede & Helge Möllmann

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  1. Stanislav Keranov
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Keranov, S., Kim, WK., Arsalan, M. et al. Predictive value of preprocedural procalcitonin for short- and long-term mortality after transfemoral transcatheter aortic valve implantation. Heart Vessels 34, 1993–2001 (2019). https://doi.org/10.1007/s00380-019-01448-4

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