Association Between Discharge Blood Pressure and 1-Year Outcomes After Transcatheter Aortic Valve Implantation

抄録

Background: Transcatheter aortic valve implantation (TAVI) is increasingly common in older adults with severe aortic stenosis. Changes in systemic blood pressure after TAVI have been reported, however, prognostic significance of low systolic blood pressure (sBP) at discharge remains unclear.

Methods: We retrospectively analyzed 946 patients who underwent TAVI at our institution between January 2016 and March 2023. Patients were categorized into two groups according to their discharge sBP: <90 mmHg and ≥90 mmHg. The primary endpoint was a composite of all-cause mortality and heart failure rehospitalization. Secondary endpoints included all-cause mortality and heart failure rehospitalization.

Results: 941 patients were included in the study. The sBP <90 mmHg group (n=27) had higher surgical risk and frailty than the sBP ≥90 mmHg group (STS 6.2 [4.1—11.6] vs. 4.8 [3.4—7.2]; Clinical Frailty Scale 5 [4—6] vs. 4 [3—5]). The 1-year composite endpoint did not differ between groups, and the secondary endpoints were similar. In multivariable analyses adjusting for history of hypertension, admission sBP, age, sex, and STS, discharge sBP<90 mmHg was not associated with the 1-year composite outcome (adjusted OR 1.22 [95% CI 0.41—3.64], p=0.725).

Conclusion: Among patients undergoing TAVI, discharge sBP <90 mmHg was not associated with worse 1-year outcomes despite higher baseline frailty and comorbidity burden, underscoring the value of individualized physiology-guided blood pressure management after TAVI.