Prevalence and influence of cardiovascular kidney metabolic syndrome on outcomes after transcatheter aortic valve implantation

BACKGROUND: The cardiovascular-kidney-metabolic syndrome (CKM) is a multisystem disorder increasingly recognized for its association with adverse outcomes. The incidence and prognostic relevance of CKM in patients undergoing transcatheter aortic valve implantation (TAVI) has not been investigated. METHODS AND RESULTS: A double center, retrospective analysis of patients undergoing TAVI from 2011 to 2024 was performed. CKM syndrome was diagnosed and quantified using a simplified definition based on the presence of atherosclerotic cardiovascular diseases (ASCVD), chronic kidney disease (CKD), and diabetes mellitus (DM). The prevalence of CKM and its association with procedural success, bleeding events, permanent pacemaker implantation and 1-year mortality was evaluated.Among 5,834 TAVI patients, 5,280 (90%) fulfilled criteria for CKM. The overall prevalence remained stable. Procedural success was highest in patients with no CKM conditions, followed by patients with 1 and 2 CKM conditions. Patients with 3 CKM conditions had the worst procedural success (p=0.002). Patients with 2 and 3 CKM conditions had higher probability of death within 1 year as compared to patients with no CKM conditions and 1 CKM condition (HR for 2 CKM conditions 1.40, p=0.030, HR for 3 CKM conditions 1.88, p<0.001). Patients with 3 CKM conditions had higher rates of permanent pacemaker implantation (OR 1.45, p=0.02), but not of major bleeding (HR 1.24, p=0.328). After adjustment for baseline differences in comorbidities and patient characteristics, 3/3 CKM conditions remained associated with increased all-cause mortality at 1, 2 and 5 years. CONCLUSION: CKM is highly prevalent in patients undergoing TAVI. Higher CKM condition burden was associated with adverse outcomes.