Key result
Chronic steroid therapy was associated with a significantly increased risk of major vascular complications (RR 2.32) and major bleeding (RR 1.61) following transcatheter aortic valve replacement.
Why the study?
The association between chronic steroid therapy and vascular complications after TAVR remained uncertain, with conflicting results reported.
Does chronic steroid therapy increase vascular complications and adverse outcomes in patients undergoing TAVR?
Meta-Analysis (n=6,136)
Does chronic steroid therapy increase vascular complications and adverse outcomes in patients undergoing TAVR?
Relative Risk: 2.32 (95% CI 1.73–3.11)
Absolute Event Rate: 12.5% vs 6.7%
p-value: p=<0.001
Chronic steroid therapy in patients undergoing TAVR is associated with a significantly increased risk of major vascular complications, major bleeding, and aortic annulus rupture.
Chronic steroid use may heighten vascular and bleeding risks in TAVR; leaves open causality versus confounding.
BACKGROUND: Chronic steroid (CS) therapy was reportedly linked to increased vascular complications following percutaneous coronary intervention. However, its association with vascular complications after transcatheter aortic valve replacement (TAVR) remained uncertain, with conflicting results being reported. OBJECTIVE: The authors aimed to compare the rate of vascular complications and outcomes between patients with and without CS use after TAVR. METHODS: The authors conducted a comprehensive literature search in PubMed, Embase, and Cochrane databases from their inception until 18th April 2022 for relevant studies. Endpoints were described according to Valve Academic Research Consortium-2 definitions. Effect sizes were pooled using DerSimonian and Laird random-effects model as risk ratio (RR) with 95% CI. RESULTS: Five studies with 6136 patients undergoing TAVR were included in the analysis. The included studies were published between 2015 and 2022. The mean ages of patients in both study groups were similar, with the CS group averaging 80 years and the nonsteroid group averaging 82 years. Notably, a higher proportion of patients in the CS group were female (56%) compared to the nonsteroid group (54%). CS use was associated with a significantly higher risk of major vascular complications (12.5 vs. 6.7%, RR 2.32, 95% CI: 1.73-3.11, P <0.001), major bleeding (16.8 vs. 13.1%, RR 1.61, 95% CI: 1.27-2.05, P <0.001), and aortic annulus rupture (2.3 vs. 0.6%, RR 4.66, 95% CI: 1.67-13.01, P <0.001). There was no significant difference in terms of minor vascular complications (RR 1.43, 95% CI: 1.00-2.04, P =0.05), in-hospital mortality (2.3 vs. 1.4%, RR 1.86, 95% CI: 0.74-4.70, P =0.19), and 30-day mortality (2.9 vs. 3.1%, RR 1.14, 95% CI: 0.53-2.46, P =0.74) between both groups. CONCLUSION: Our study showed that CS therapy is associated with increased major vascular complications, major bleeding, and annulus rupture following TAVR. Further large multicenter studies or randomized controlled trials are warranted to validate these findings.
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Ang et al. (2024) conducted a meta-analysis in Severe aortic stenosis requiring TAVR (n=6,136). Chronic steroid therapy vs. No chronic steroid therapy was evaluated on Major vascular complications (RR 2.32, 95% CI 1.73-3.11, p=<0.001). Chronic steroid therapy was associated with a significantly increased risk of major vascular complications (RR 2.32) and major bleeding (RR 1.61) following transcatheter aortic valve replacement.
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