Inadequacy of existing clinical prediction models for predicting mortality after transcatheter aortic valve implantation

Martin, Glen P.; Sperrin, Matthew; Ludman, Peter; Belder, Mark de; Gale, Chris P; Toff, William D.; Moat, Neil; Trivedi, Uday; Buchan, Iain; Mamas, Mamas A.

doi:10.1016/j.ahj.2016.10.020

Cited by 44 publications

(65 citation statements)

References 40 publications

(113 reference statements)

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“…Their performance is recognised to be limited, and this was also confirmed when these models are applied to the UK dataset 9. The addition of frailty measures, however, does improve risk prediction 10.…”

Section: Discussionmentioning

confidence: 83%

UK TAVI registry

Ludman

2019

Heart

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The UK Transcatheter Aortic Valve Implantation (TAVI) registry has collected data about every TAVI procedure performed in the UK. The latest data are from 2016 when 3250 procedures (49.5 pmp) were performed. There has been no change in the mean age of patients but there has been a shift to lower risk with fall in mean Logistic Euroscore since 2012. The switch from general anaesthetic to conscious sedation has been rapid, and propensity-adjusted analysis has not shown a difference in outcomes. In-hospital mortality has fallen to 1.8% in 2016, and relative survival analysis has shown outcome the same as the matched general population to 3 years. The UK TAVI registry has provided valuable benchmarks, and a risk adjustment model that includes frailty measures has been successfully developed and is available online.

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Section: Discussionmentioning

confidence: 83%

UK TAVI registry

Ludman

2019

Heart

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“…The poor performance of the STS score and the LES/ESII are due to the fact that they were derived for predicting surgical populations with different clinical characteristics from those of TAVI cohorts 29. Thus, precluding accurate model calibrations to perform in TAVI patients that were excluded from SAVR by virtue of certain comorbidities, such as porcelain aorta, chest radiation/hostile chest, cancer, immunodeficiency, liver disease/cirrhosis and frailty that, among others, are not computed into the STS score and LES/ESII risk models.…”

Section: Discussionmentioning

confidence: 99%

Association of comorbid burden with clinical outcomes after transcatheter aortic valve implantation

Bagur

Martin

Nombela‐Franco

et al. 2018

Heart

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1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 Conclusion:In this multi-centre international study, patients undergoing TAVI had significant comorbid burden. We found a weak correlation between the CCI and well-established preoperative risks scores. The CCI had a moderate association with long-term mortality up-to 5-years post TAVI.

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“…Several clinical prediction models for TAVI have been suggested [ 6 – 8 , 20 ], so that the “eyeball test” does not need to be used. Nevertheless, despite including multiple parameters, the predictive power is still rather inadequate [ 21 ]. Thus, there is an urgent need for the characterization of potentially threatened patients, including readmission [ 22 ] and all-cause mortality [ 23 ].…”

Section: Discussionmentioning

confidence: 99%

Nutrition and mobility predict all-cause mortality in patients 12 months after transcatheter aortic valve implantation

et al. 2017

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BackgroundThe aim of the study was to determine pre-interventional predictors for all-cause mortality in patients after transcatheter aortic valve implantation (TAVI) with a 12-month follow-up.MethodsFrom 10/2013 to 07/2015, 344 patients (80.9 ± 5.0 years, 44.5% male) with an elective TAVI were consecutively enrolled prospectively in a multicentre cohort study. Prior to the intervention, sociodemographic parameters, echocardiographic data and comorbidities were documented. All patients performed a 6-min walk test, Short Form 12 and a Frailty Index (score consisting of activities of daily living, cognition, nutrition and mobility). Peri-interventional complications were documented. Vital status was assessed over telephone 12 months after TAVI. Predictors for all-cause mortality were identified using a multivariate regression model.ResultsAt discharge, 333 patients were alive (in-hospital mortality 3.2%; n = 11). During a follow-up of 381.0 ± 41.9 days, 46 patients (13.8%) died. The non-survivors were older (82.3 ± 5.0 vs. 80.6 ± 5.1 years; p = 0.035), had a higher number of comorbidities (2.6 ± 1.3 vs. 2.1 ± 1.3; p = 0.026) and a lower left ventricular ejection fraction (51.0 ± 13.6 vs. 54.6 ± 10.6%; p = 0.048). Additionally, more suffered from diabetes mellitus (60.9 vs. 44.6%; p = 0.040). While the global Frailty Index had no predictive power, its individual components, particularly nutrition (OR 0.83 per 1 pt., CI 0.72–0.95; p = 0.006) and mobility (OR 5.12, CI 1.64–16.01; p = 0.005) had a prognostic impact. Likewise, diabetes mellitus (OR 2.18, CI 1.10–4.32; p = 0.026) and EuroSCORE (OR 1.21 per 5%, CI 1.07–1.36; p = 0.002) were associated with a higher risk of all-cause mortality.ConclusionsBesides EuroSCORE and diabetes mellitus, nutrition status and mobility of patients scheduled for TAVI offer prognostic information for 1-year all-cause mortality and should be advocated in the creation of contemporary TAVI risk scores.

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Inadequacy of existing clinical prediction models for predicting mortality after transcatheter aortic valve implantation

Cited by 44 publications

References 40 publications

UK TAVI registry

UK TAVI registry

Association of comorbid burden with clinical outcomes after transcatheter aortic valve implantation

Nutrition and mobility predict all-cause mortality in patients 12 months after transcatheter aortic valve implantation

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