Multidimensional Prognostic Index and Outcomes in Older Patients Undergoing Transcatheter Aortic Valve Implantation: Survival of the Fittest.

Jeannette A Goudzwaard,Alberto Pilotto,Francesco U S Mattace-Raso,Marjo J A G De Ronde-Tillmans,Nicolas M Van Mieghem,Maarten P H Van Wiechen,Joris F W Ooms,Harmke A Polinder-Bos,Mattie J Lenzen,Peter P T De Jaegere,Sadhna Chotkan,Joost Daemen,Madelon De Beer-Leentfaar

doi:10.3390/jcm10163529

Abstract

Selecting patients with a high chance of endured benefit from transcatheter aortic valve implantation (TAVI) is becoming relevant with changing indications and increasing number of TAVI being performed. The aim of our study was to investigate the association of the multidimensional prognostic index (MPI) based on a comprehensive geriatric assessment (CGA) on survival. The TAVI Care & Cure program is a prospective, observational registry of patients referred for TAVI at the Erasmus MC University Medical Center. Consecutive patients who underwent a complete CGA and TAVI were included. CGA components were used to calculate the MPI score. The impact of the MPI score on survival was evaluated using Cox regression. Furthermore, 376 patients were included, 143 (38.0%) patients belonged to the MPI-1 group and 233 (61.9%) patients to the MPI-2–3 group. After 3 years, 14.9% of the patients in the MPI-1 group and 30.5% of the patients in the MPI-2–3 group died (p = 0.001). Patients in MPI-1 had increased chances of overall survival in comparison with patients in MPI group 2–3 Hazard Ratio (HR) 0.57, (95% Confidence Interval (CI) 0.33–0.98)). In this study we found that the MPI tool could be useful to assess frailty and to predict which patient will have a higher chance of enduring benefit from a TAVI procedure.

Highlights

In this study we found that the multidimensional prognostic index (MPI) tool is useful to assess frailty and could be able to predict survival after transcatheter aortic valve implantation (TAVI)
One- and three-year survival rates were 92% and 85% in patients belonging to MPI-1, corresponding survival rates were 85% and 69.5% in patients belonging to MPI-2–3, respectively
This study shows that the MPI tool could be helpful in the decision-making process

Summary

Introduction

Performing a comprehensive geriatric assessment (CGA) is a growing routine practice and the impact of frailty status of patients on outcomes after TAVI is increasingly described [6,7,8,9]. Multicenter, longitudinal study, the MPI has shown to be predictive of mortality and negative health outcomes in older, hospitalized patients [13]. Recent studies in relatively small groups of patients, have suggested that the MPI can predict death and stroke for up to three months after TAVI, and mortality for up to one year after TAVI [14,15,16]. The aim of this study was to investigate the association between the MPI and survival at 1 and 3 years in older patients undergoing TAVI

Objectives

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Results

Conclusion