Elevation of B-type natriuretic peptide at discharge is associated with 2-year mortality after transcatheter aortic valve replacement in patients with severe aortic stenosis: Insights from a multicenter prospective OCEAN-TAVI (Optimized Transcatheter Valvular Intervention-Transcatheter Aortic Valve Implantation) registry

Background-in this study,we sought to investigate the 2-year prognostic impact of b-type natriuretic peptide (bnp) levels at discharge,following transcatheter aortic valve replacement. methods and results-we enrolled 1094 consecutive patients who underwent transcatheter aortic valve replacement between 2013 and 2016. study patients were stratified into 2 groups according to survival classification and regression tree analysis (high versus low bnp groups). we evaluated the impact of high bnp on 2-year mortality compared with that of low bnp using a multivariable cox model,and assessed whether this stratification would improve predictive accuracy for determining 2-year mortality by assessing time-dependent net reclassification improvement and integrated discrimination improvement. the median age of patients was 85 years (quartile 82-88),and 29.2% of the study population were men. the median society of thoracic surgeons score was 6.8 (4.7-9.5),and bnp at discharge was 186 (93-378) pg/ml. all-cause mortality following discharge was 7.9% (95% ci,5.8-9.9%) at 1 year and 15.4% (95% ci,11.6-19.0%) at 2 years. the survival classification and regression tree analysis revealed that the discriminating bnp level to discern 2-year mortality was 202 pg/ml,and that elevated bnp had a statistically significant impact on outcomes,with an adjusted hazard ratio of 2.28 (1.36-3.82,p=0.002). the time-dependent net reclassification improvement (p=0.047) and integrated discrimination improvement (p=0.029) analysis revealed that the incorporation of bnp stratification with other clinical variables significantly improved predictive accuracy for 2-year mortality. conclusions-elevation of bnp at discharge is associated with 2-year mortality after transcatheter aortic valve replacement. © 2017 the authors.