Valvular & structural heart diseaseCohort study
Incidence, Predictors, and Prognostic Impact of Bleeding Events After Transcatheter Aortic Valve Replacement (TAVR) According to VARC-3 Criteria
- Prospective cohort study
- consecutive patients
Authors' conclusion
Bleeding events after TAVR were associated with poorer short- and long-term survival. The magnitude of this correlation was proportional to bleeding severity defined according to VARC-3 criteria.
Study context
- Population
- Patients with severe symptomatic AS undergoing TAVR
- Participants
- 2,384 consecutive patients
- Exposure
- Bleeding events vs no bleeding after TAVR
- Type 1n = 169
- Type 2n = 399
- Type 3n = 149
- Type 4n = 44
- Outcome
- Incidence, predictors and clinical impact of bleeding events (VARC-3)
- Follow-up
- 24 [IQR: 12-43] months
Main finding
As reported in the abstract
Bleeding events (VARC-3) by type
- Any bleeding event
- 761 patients (31.9%)
- Type 1 bleeding
- 169 (22.2%)
- Type 2 bleeding
- 399 (52.4%)
- Type 3 bleeding
- 149 (19.6%)
- Type 4 bleeding
- 44 (5.8%)
Observational data: associations, not effects.
Further findings
Mortality by bleeding type · 30-day and 1-year
| Comparison | HR (95% CI) | P value | |
|---|---|---|---|
| Type 2 · 30-day | 2.94 (1.43–6.03) | P = 0.003 | |
| Type 3 · 30-day | 4.91 (2.19–11.03) | P < 0.001 | |
| Type 2 · 1-year | 1.86 (1.28–2.69) | P = 0.001 | |
| Type 3 · 1-year | 2.28 (1.41–3.66) | P = 0.001 | |
| 0.050.21520Hazard ratio (log scale) |
Predictors of early bleeding
- Female sex, thoracotomy access, larger (14-F) sheath, DAPT increased risk
- P < 0.02 for all
- Radial artery secondary access reduced risk
- P < 0.001
Early bleeding incidence, VARC-2 vs VARC-3
- Lower global incidence with VARC-2 (19% vs 27%)
- P < 0.001
- similar prognostic pattern with VARC-2
Original publication
Incidence, Predictors, and Prognostic Impact of Bleeding Events After TAVR According to VARC-3 Criteria. JACC Cardiovasc Interv. Published 6 September 2023. doi:10.1016/j.jcin.2023.07.005
Summarised from the published abstract; every number is checked against it