After transcatheter aortic valve implantation (TAVI) there is consistently identified
decrease in platelets accompanied by a leucocyte (white blood cell, WBC) increase.
We aimed to analyze the prognostic value of early platelet and WBC count changes (thromboinflammatory
response) after successful TAVI. Among 432 consecutive patients [median 83.0 years
of age, 63.4% women], platelets and WBCs were measured before and for 7 days post-TAVI.
Follow-up was 36.9 (21.4 to 48.0) months. Platelet decrease (∆%Platelet-max) and parallel
WBC increase (∆%WBC-max) were seen at days 1 to 3. Both ∆%Platelet-max ≤−37.6% and
∆%WBC-max >72.5% predicted mortality (area under the curve = 0.569 and area under
the curve = 0.626). The 30-day and 1-year mortality (13.1% and 26.2%) were highest
among 28% patients with a greater decrease in platelets and a greater increase in
WBCs; intermediate (0.9% and 12.3%) among 52.5% patients with either a greater decrease
in platelets or a greater increase in WBCs, but not both; and lowest (0% and 6.6%)
among 19.5% patients with a lesser decrease in platelets and a lesser increase in
WBCs (p <0.001). Estimated 4-year mortality rates were 53.7% versus 36.2% versus 24.5%,
respectively, p <0.001. Bleeding, surgical wounds, acute kidney, and brain injury
predicted a more intense thromboinflammatory response, whereas use of the newer generations
had the opposite effect. In conclusion, substantial thromboinflammatory response identified
after successful TAVI predicts a higher long-term mortality.
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Article info
Publication history
Published online: September 09, 2019
Received in revised form:
August 17,
2019
Received:
July 30,
2019
Identification
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© 2019 Elsevier Inc. All rights reserved.
