Few studies have evaluated the impact of new comorbidities, fragility and disability indices on transcatheter aortic valve replacement (TAVI) outcomes.
This study analyzes Medtronic CoreValve U.S. Pivotal patients to develop a new, simpler scoring system to use in addition to the standard assessment of TAVI patients.
A multidisciplinary heart team used objective criteria, the STS PROM (The Society of Thoracic Surgeons Predicted Risk of Mortality) and subjective criteria, fragility, to assess eligibility for TAVI.
The analyzis included 3,687 patients randomized 2:1 into a derivation cohort (n=2482) and a validation cohort (n=1205). The study assessed predictors of all-cause mortality, used to calculate a risk score for each patient.
Overall mortality at 30 days was 5.8%, and 22.8% at one year.
Predictors of mortality at 1 year were:
- excessive use of home oxygen
- assisted living
- albumin levels <3.3 g/dl
- falls in the past 6 months
- STS PROM >7%.
- Charlson comorbidity score ≥5.
A simple scoring system based on these predictors could effectively stratify risk at 30 days and one year into low, moderate and high risk.
This score showed a 3 fold difference in mortality rate at 30 days in the low and high risk groups:
Low Risk: 3.6%
High Risk: 10.9%
And a similar difference at one year:
Low Risk: 12.3%
High Risk: 36.6%
The prediction model at one year was more stable and accurate than the one at 30 days.
Conclusion
A simple score based on new predictors effectively stratified mortality risk at short and long term in TAVI patients.
Original Title: Predicting Early and Late Mortality After Transcatheter Aortic Valve Replacement.
Reference: Hermiller JB Jr et al. J Am Coll Cardiol. 2016 Jul 26;68(4):343-52.
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