Preprocedural anemia in females undergoing transcatheter aortic valve implantation: Insights from the WIN-TAVI registry

Objectives To assess the impact of anemia on clinical outcomes in female patients enrolled in the Women's InterNational transcatheter aortic valve implantation (WIN-TAVI) registry. Background Anemia is highly prevalent among females who constitute half of TAVI candidates, yet, its clinical significance remains poorly investigated. Methods Patients were divided into three groups according to preprocedural hemoglobin (Hb) level: (1) no anemia (Hb >= 12 g/dl), (2) mild-to-moderate anemia (10 <= Hb <12 g/dl), and (3) severe anemia (Hb <10 g/dl). The primary outcome was the occurrence of Valve Academic Research Consortium (VARC)-2 efficacy endpoint, a composite of mortality, stroke, myocardial infarction (MI), hospitalization for valve-related symptoms or heart failure or valve-related dysfunction at 1-year follow-up. Results Hemoglobin level was available in 877 (86.1%) patients: 412 (47.0%) had no anemia, 363 (41.4%) had mild-to-moderate anemia, and 102 (11.6%) had severe anemia. The latter group had a higher prevalence of cardiovascular risk factors. Compared with patients without anemia, severe anemia was associated with a greater risk of VARC-2 efficacy endpoint (adjHR 1.71, 95% CI: 1.02-2.87,p= .04), all-cause death (adjHR 2.36, 95% CI: 1.31-4.26,p= .004) and a composite of death, MI or stroke (adjHR 1.88, 95% CI: 1.10-3.22,p= .02) at 1 year. Moreover, an increased risk of late mortality (adjHR 1.15, 95% CI: 1.02-1.30,p= .03) was observed with every 1 g/dl decrease in hemoglobin level. Conclusion Severe anemia in females undergoing TAVI was independently associated with increased rates of VARC-2 efficacy endpoint and mortality at 1 year.