Development of a risk score for outcome after transcatheter aortic valve implantation
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Development of a risk score for outcome after transcatheter aortic valve implantation. / Seiffert, Moritz; Sinning, Jan-Malte; Meyer, Alexander; Wilde, Sandra; Conradi, Lenard; Vasa-Nicotera, Mariuca; Ghanem, Alexander; Kempfert, Jörg; Hammerstingl, Christoph; Ojeda, Francisco M; Kim, Won-Keun; Koschyk, Dietmar H; Schirmer, Johannes; Baldus, Stephan; Grube, Eberhard; Möllmann, Helge; Reichenspurner, Hermann; Nickenig, Georg; Blankenberg, Stefan; Diemert, Patrick; Treede, Hendrik; Walther, Thomas; Werner, Nikos; Schnabel, Renate B.
In: CLIN RES CARDIOL, Vol. 103, No. 8, 08.2014, p. 631-640.Research output: SCORING: Contribution to journal › SCORING: Journal article › Research › peer-review
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TY - JOUR
T1 - Development of a risk score for outcome after transcatheter aortic valve implantation
AU - Seiffert, Moritz
AU - Sinning, Jan-Malte
AU - Meyer, Alexander
AU - Wilde, Sandra
AU - Conradi, Lenard
AU - Vasa-Nicotera, Mariuca
AU - Ghanem, Alexander
AU - Kempfert, Jörg
AU - Hammerstingl, Christoph
AU - Ojeda, Francisco M
AU - Kim, Won-Keun
AU - Koschyk, Dietmar H
AU - Schirmer, Johannes
AU - Baldus, Stephan
AU - Grube, Eberhard
AU - Möllmann, Helge
AU - Reichenspurner, Hermann
AU - Nickenig, Georg
AU - Blankenberg, Stefan
AU - Diemert, Patrick
AU - Treede, Hendrik
AU - Walther, Thomas
AU - Werner, Nikos
AU - Schnabel, Renate B
PY - 2014/8
Y1 - 2014/8
N2 - AIMS: Transcatheter aortic valve implantation (TAVI) is an increasingly common procedure in elderly and multimorbid patients with aortic stenosis. We aimed at developing a pre-procedural risk evaluation scheme beyond current surgical risk scores.METHODS: We developed a risk algorithm for 1-year mortality in two cohorts consisting of 845 patients undergoing routine TAVI procedures by commercially available devices, mean age 80.9 ± 6.5, 51 % women. Clinical variables were determined at baseline. Multivariable Cox regression related clinical data to mortality (n = 207 deaths).RESULTS: To account for variability related to age and sex and by enrolment site we forced age, sex, and cohort into the score model. Body mass index, estimated glomerular filtration rate, hemoglobin, pulmonary hypertension, mean transvalvular gradient and left ventricular ejection fraction at baseline were most strongly associated with mortality and entered the risk prediction algorithm [C-statistic 0.66, 95 % confidence interval (CI) 0.61-0.70, calibration χ (2)-statistic = 6.51; P = 0.69]. Net reclassification improvement compared to existing surgical risk predication schemes was positive. The score showed reasonable model fit and calibration in external validation in 333 patients, N = 55 deaths (C-statistic 0.60, 95 % CI 0.52-0.68; calibration χ (2)-statistic = 16.2; P = 0.06). Additional measurement of B-type natriuretic peptide and troponin I did not improve the C-statistic. Frailty increased the C-statistic to 0.71, 95 % CI 0.65-0.76.CONCLUSIONS: We present a new risk evaluation tool derived and validated in routine TAVI cohorts that predicts 1-year mortality. Biomarkers only marginally improved risk prediction. Frailty increased the discriminatory ability of the score and needs to be considered. Risk algorithms specific for TAVI may help to guide decision-making when patients are evaluated for TAVI.
AB - AIMS: Transcatheter aortic valve implantation (TAVI) is an increasingly common procedure in elderly and multimorbid patients with aortic stenosis. We aimed at developing a pre-procedural risk evaluation scheme beyond current surgical risk scores.METHODS: We developed a risk algorithm for 1-year mortality in two cohorts consisting of 845 patients undergoing routine TAVI procedures by commercially available devices, mean age 80.9 ± 6.5, 51 % women. Clinical variables were determined at baseline. Multivariable Cox regression related clinical data to mortality (n = 207 deaths).RESULTS: To account for variability related to age and sex and by enrolment site we forced age, sex, and cohort into the score model. Body mass index, estimated glomerular filtration rate, hemoglobin, pulmonary hypertension, mean transvalvular gradient and left ventricular ejection fraction at baseline were most strongly associated with mortality and entered the risk prediction algorithm [C-statistic 0.66, 95 % confidence interval (CI) 0.61-0.70, calibration χ (2)-statistic = 6.51; P = 0.69]. Net reclassification improvement compared to existing surgical risk predication schemes was positive. The score showed reasonable model fit and calibration in external validation in 333 patients, N = 55 deaths (C-statistic 0.60, 95 % CI 0.52-0.68; calibration χ (2)-statistic = 16.2; P = 0.06). Additional measurement of B-type natriuretic peptide and troponin I did not improve the C-statistic. Frailty increased the C-statistic to 0.71, 95 % CI 0.65-0.76.CONCLUSIONS: We present a new risk evaluation tool derived and validated in routine TAVI cohorts that predicts 1-year mortality. Biomarkers only marginally improved risk prediction. Frailty increased the discriminatory ability of the score and needs to be considered. Risk algorithms specific for TAVI may help to guide decision-making when patients are evaluated for TAVI.
KW - Aged
KW - Aged, 80 and over
KW - Algorithms
KW - Aortic Valve Stenosis/surgery
KW - Biomarkers/metabolism
KW - Cohort Studies
KW - Female
KW - Follow-Up Studies
KW - Frail Elderly
KW - Humans
KW - Male
KW - Middle Aged
KW - Multivariate Analysis
KW - Outcome Assessment, Health Care
KW - Proportional Hazards Models
KW - Prospective Studies
KW - Registries
KW - Risk Assessment
KW - Risk Factors
KW - Transcatheter Aortic Valve Replacement/methods
U2 - 10.1007/s00392-014-0692-4
DO - 10.1007/s00392-014-0692-4
M3 - SCORING: Journal article
C2 - 24643728
VL - 103
SP - 631
EP - 640
JO - CLIN RES CARDIOL
JF - CLIN RES CARDIOL
SN - 1861-0684
IS - 8
ER -
