Study: TAVR Patients with High CRP Levels at risk of Increased Infection Risks

Transcatheter aortic valve replacement (TAVR) has revolutionized the treatment of aortic valve stenosis, offering a minimally invasive alternative to open-heart surgery for many patients. Recent research has delved into the role of elevated C-reactive protein (CRP) levels before TAVR. However, there is no clarity on its impact on the long-term results of TAVR. Considering this, Stefan Toggweiler, From the Heart Center Lucerne, Cardiology Division, Luzerner Kantonsspital, Lucerne, Switzerland, and colleagues aimed to investigate the long-term (up to six years) clinical outcomes of TAVR patients with normal compared to elevated CRP levels before TAVR.

For this purpose, the researchers included consecutive patients undergoing TAVR between 2012 and 2023 at a tertiary cardiology facility. They were categorized into two cohorts based on the baseline CRP levels: normal CRP (≤ 5 mg/l) and elevated CRP (>5 mg/l). Patients were clinically monitored for up to six years following TAVR.

According to the authors, the study is the first to comprehensively examine outcomes after TAVR in patients with pre-procedural CRP elevation during a prolonged follow-up period of up to six years.

The study led to the following findings:

• From a total of 1000 TAVR patients (mean age 81 ± 6 years), 27 % of patients had elevated baseline CRP (>5 mg/l).
• Such patients had significantly more co-morbidities (e.g., chronic obstructive pulmonary disease, atrial fibrillation, heart failure, concomitant valvopathies).
• They also developed periprocedural infections more frequently (3 % versus 1 %) and required more commonly repeat hospitalizations for infections during follow-up (HR 1.97).
• All-cause mortality and development of valve dysfunction did not significantly differ between patients with elevated and normal baseline CRP levels.

"Our study found that patients with elevated CRP levels undergoing TAVR experienced favorable long-term outcomes, with no significant differences in long-term survival or valve dysfunction compared to those with normal CRP levels. However, elevated baseline CRP was associated with increased rates of periprocedural infections and hospital readmissions due to infections," the researchers concluded.

Reference:

Brunner, S., Moccetti, F., Loretz, L., Conrad, N., Bossard, M., Attinger-Toller, A., Kurmann, R., Cuculi, F., Wolfrum, M., & Toggweiler, S. (2024). The impact of elevated C-reactive protein levels on long-term outcomes of patients undergoing transcatheter aortic valve replacement. Cardiovascular Revascularization Medicine. https://doi.org/10.1016/j.carrev.2024.07.002