P1657An early and substantial systemic thrombo-inflammatory response after TAVI could indicate frail patient population of subsequently higher long-term mortality

Background: Platelet count (PLT) decrease or WBC count increase (suggesting systemic inflammation) after TAVI might indicate a frail pt population at risk for a high rate of events. Purpose: To study patterns of PLT and WBC count changes and their impact on long-term outcomes after TAVI in a large consecutive pt population. Methods: Among 446 consecutive pts [80.5±7.3 yrs, 63% female, median EuroSCORE II = 3.4% (min 0.5% - max 27.7%)] treated with TAVI (8/2009–10/2017), serial changes in PLT and WBC were measured prior to and daily for 7 days post-procedure. Results: Median follow-up was 1.9 yrs (min 7 days – max 8.3 yrs). Overall mortality was 29.8% (137/446), with 8 pts (1.8%) dying <7days after TAVI (7 pts on the same day and 1 on a subsequent day after the procedure). An early PLT drop was seen on day 1, reaching nadir on day 2–3 [median Δ%PLTmax = -42% (-53% to -32%)]. An early WBC rise was seen on day 1, reaching its maximal level at day 1–2 [median Δ%WBCmax = 45% (18% to 76%)](Fig. 1A). Δ%PLTmax of ≤-38% (75.6 sensitivity & 40.7 specificity, p=0.015) and Δ%WBCmax >73% (43.2 & 79.0, p<0.001, respectively) proved valid cut-offs to predict subsequent mortality >7 days post-TAVI. Mortality rates were highest in Group 3 (51.2%: those with a greater drop in PLTs and a greater increase in WBCs, as per ROC analysis), intermediate in Group 2 (28.8%: those with either a greater drop in PLTs or a greater increase in WBCs, but not both), and lowest in Group 1 (15.8%: those with a lesser drop in PLTs and a lesser increase in WBCs) (p<0.001) (Fig. 1B).