Additive prognostic value of carbohydrate antigen‐125 over frailty in patients undergoing transcatheter aortic valve replacement

Abstract

Background To evaluate the additive prognostic value of myocardial, inflammatory, and renal biomarkers according to frailty status in patients undergoing transcatheter aortic valve replacement (TAVR) for aortic stenosis (AS). Methods A total of 111 subjects who underwent TAVR at Hospital Italiano de Buenos Aires, Argentina between January 2016 and December 2018 were retrospectively reviewed. Plasma levels of N‐terminal pro‐B‐type natriuretic peptide (NT‐proBNP), high sensitivity troponin T (hs‐cTnT), C‐reactive protein (CRP), cystatin‐c (Cys‐C) and carbohydrate antigen‐125 (CA‐125) were assessed prior to TAVR. Frailty status was assessed according to the fried physical frailty phenotype (FPFP). The primary endpoint was defined as all‐cause death and/or readmission for worsening congestive heart failure (CHF) within the first year after TAVR. Results Of the 111 patients included, 48/111 (43%) were considered to be “frail” according to the FPFP. Among biomarkers, we found CA‐125 to be strongly associated with the primary endpoint (p = .006). CA‐125 ≥ 18.2 U/ml was present in 41% and was associated with a higher rate of the primary endpoint (31% vs. 9%; p = .003). After multivariable adjustment, CA‐125 ≥ 18.2 U/ml (hazard ratio [HR] 3.17; p = .024) was the only independent predictor of the primary endpoint. Finally, the inclusion of CA‐125 to frailty significantly improved C‐index (0.68–0.74; p < .05), and provided a Net Reclassification Improvement (NRI) of 0.34 (95% CI 0.19–0.49, p = .031), largely through reductions in risk estimates among pre‐frail and frail patients. Conclusions CA‐125, a tumor biomarker, outperformed frailty for predicting the primary endpoint within the first year after TAVR.

Association Between Previous or Active Cancer and Clinical Outcomes in TAVR Patients: A Systematic Review and Meta-Analysis of 255,840 Patients

“…After the removal of 365 duplicates, 589 articles underwent title/abstract screening, of which 51 articles were included in the full-text screening. Finally, a total of 13 studies were selected (Figure 1) (2)(3)(4)(5)(12)(13)(14)(15)(16)(17)(18)(19)(20).…”

Differential utility of various frailty diagnostic tools in non‐geriatric hospital departments of several countries: A longitudinal study

“…Most of the studies evaluated frailty screening tools in a cohort of patients with the same disease or entity or in the same clinical setting (i.e. CHF, transcatheter aortic valve replacement) 22,24–27 …”

“…CHF, transcatheter aortic valve replacement). 22,[24][25][26][27] However, frailty is very common in hospitalized patients (30% in a meta-analysis of European studies) 28 and admission into hospital entails a major risk factor for developing disability or death in older people: approximately 30%-60% of hospitalized older people lose the ability to perform relevant activities of daily living, compared with their preadmission level of functioning. 29 At the same time, hospitalization has been shown to be an impediment to recovery from frailty or prefrailty states.…”

Prognostic role of CA‐125 in patients undergoing transcatheter aortic valve replacement: A systematic review and meta‐analysis

“…However, it has also been found to be elevated in a range of other malignancies as well as in nonneoplastic conditions such as cardiovascular disease 4 . Recent studies have assessed the utility of CA‐125 as a prognostic marker in patients undergoing TAVR, although data have been conflicting 5,6 . Therefore, this systematic review and meta‐analysis aim to synthesize the available evidence on the prognostic role of CA‐125 in patients undergoing TAVR.…”