Clinical risk model for predicting 1‐year mortality after transcatheter aortic valve replacement

Abstract

Objectives Estimating 1‐year life expectancy is an essential factor when evaluating appropriate indicators for transcatheter aortic valve replacement (TAVR). Background It is clinically useful in developing a reliable risk model for predicting 1‐year mortality after TAVR. Methods We evaluated 2,588 patients who underwent TAVR using data from the Optimized CathEter vAlvular iNtervention (OCEAN) Japanese multicenter registry from October 2013 to May 2017. The 1‐year clinical follow‐up was achieved by 99.5% of the entire population (n = 2,575). Patients were randomly divided into two cohorts: the derivation cohort (n = 1,931, 75% of the study population) and the validation cohort (n = 644). Considerable clinical variables including individual patient's comorbidities and frailty markers were used for predicting 1‐year mortality following TAVR. Results In the derivation cohort, a multivariate logistic regression analysis demonstrated that sex, body mass index, Clinical Frailty Scale, atrial fibrillation, peripheral artery disease, prior cardiac surgery, serum albumin, renal function as estimated glomerular filtration rate, and presence of pulmonary disease were independent predictors of 1‐year mortality after TAVR. Using these variables, a risk prediction model was constructed to estimate the 1‐year risk of mortality after TAVR. In the validation cohort, the risk prediction model revealed high discrimination ability and acceptable calibration with area under the curve of 0.763 (95% confidence interval, 0.728–0.795, p < .001) in the receiver operating characteristics curve analysis and a Hosmer–Lemeshow χ2 statistic of 5.96 (p = .65). Conclusions This risk prediction model for 1‐year mortality may be a reliable tool for risk stratification and identification of adequate candidates in patients undergoing TAVR.

Clinical outcomes and cumulative healthcare costs of TAVR vs. SAVR in Asia

“…In the current study, TAVR was associated with a lower risk of all-cause mortality, CV death, and major adverse cardiovascular events among patients with a relatively low hospital frailty score. This result was consistent with previous studies showing that frail patients inevitably face an elevated risk of mortality after receiving TAVR ( 31 – 33 ). All-cause mortality at 1 year after TAVR in this study (11.39%) was lower than that of the high-risk patient in the PARTNER I trial (24.2%) ( 3 ).…”

Calculated plasma volume status predicts outcomes after transcatheter aortic valve implantation

“…incremental prognostic information, when considered alongside other predictors of clinical outcomes in TAVI patients. [10][11][12][13] Accurate markers of congestion may also help guide diuretic therapy prior to TAVI. Plasma volume (PV) expansion underlies systemic congestion in cardiac patients and can be objectively estimated using validated equations based on weight and haematocrit.…”

A Risk Model for 1-Year Mortality After Transcatheter Aortic Valve Replacement From the J-TVT Registry

“…Sex (male), procedural acuity, NYHA functional class III or IV, presence of chronic obstructive pulmonary disease, peripheral vessel disease, porcelain aorta, cancer, and high serum creatinine were previously reported to be predictors following TAVR. 7 , 12 , 13 , 23 , 24 Furthermore, frailty is a well-known prognostic value after TAVR 12 , 20 , 25 , 26 , 27 and is indispensable for developing risk models following TAVR. Frailty assessment includes various indexes.…”

“… 5 , 6 , 7 , 8 , 9 However, previously reported quantitative risk assessment of long-term mortality following TAVR has been contemplated mainly using models developed from a limited number of cases at a single center or a few centers and therefore has limited generalizability. 10 , 11 , 12 , 13 …”