The serum haemoglobin to creatinine ratio predicts 1-year adverse outcomes in patients undergoing transcatheter aortic valve implantation

Abstract Background The baseline serum haemoglobin and renal function are both important predictors of adverse outcomes in patients with severe aortic valve stenosis (AS) after transcatheter aortic valve implantation (TAVI), there are no reports that has examined the correlation between those combined data and adverse outcomes, however. Purpose In this study, we examined whether the combined index of anaemia and renal failure is predictive of 1-year prognosis in patients undergoing TAVI. Methods and Results This study is a retrospective, single-centre, and observational study. Between January 2015 and June 2021, 469 consecutive patients with severe AS underwent TAVI in our hospital. After excluding dialysis patients, 458 patients were analysed in this study. Patients were categorized into three groups (tertiles) according to their value of haemoglobin to creatinine (Hgb/Cr) raio. The Hgb/Cr ratio was calculated from the serum haemoglobin and creatinine on the day before TAVI. The primary and secondary clinical outcomes measure was defines as all-cause mortality and heart failure hospitalization at 1-year after TAVI. Results The mean age was 85.5 ± 4.8 years, and the mean the Society of Thoracic Surgeons score (STS) was 7.0 ± 4.7, the mean serum creatinine, eGFR and haemoglobin were 0.97 ± 0.47 mg/dL, 49.1 ± 21.3 mL/min/1.73 m2 and 13.8 ± 5.9 g/dL, respectively. The procedural success rate and length of admission day after TAVI were equivalent for tertile 1, tertile 2, and tertile 3 groups. In-hospital mortality was higher in tertile 1, tertile 2, and tertile 3 groups, in that order (8.7% vs. 2.6% vs. 0%; p<0.01). Cumulative incidences all-cause mortality and heart failure hospitalization rate were significantly better in tertile 1, tertile 2, and tertile 3 groups, in that order, respectively (16.9% vs. 7.2% vs. 2.0%; p<0.01, 10.7% vs. 3.4% vs. 0.7%; p<0.01, respectively). The index of the area under curve of Hgb/Cr ratio for all-cause mortality and heart failure hospitalization at 1-year after TAVI were 0.73 and 0.73, respectively. The cut-off values were 10.1 for all-cause mortality (odds ratio: 4.78; 95% confidence interval; 2.43-9.74; p<0.01) and 10.4 for heart failure hospitalization (odds ratio: 5.3; 95% confidence interval; 2.21-14.1; p<0.01). Conclusions The Hgb/Cr ratio was associated with all-cause mortality and heart failure hospitalization in patients who underwent TAVI. Calculation of Hgb/Cr ratio on the day before TAVI could be useful for predicting adverse outcomes at 1-year in patients undergoing TAVI.