Abstract
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.
Highlights
The prevalence of aortic stenosis (AS) as the most frequent valve disease is still rising due to the demographic change and an aging population [1]
While reduced baseline performance status is a well-established predictor of operative risk [5], an overall frailty assessment should be relevant for patients with severe aortic stenosis referred to transcatheter aortic valve implantation (TAVI)
(12.5%); major vascular complications were detected in 28 cases (8.1%), while 11 patients died
Summary
The prevalence of aortic stenosis (AS) as the most frequent valve disease is still rising due to the demographic change and an aging population [1]. Several clinical prediction models including the surgical EuroSCORE, the Society of Thoracic Surgeons (STS) score as well as the more TAVI-specific FRANCE-2 [6], German Aortic Valve [7] and the OBSERVANT score [8] were established to estimate the peri-interventional risk. While reduced baseline performance status is a well-established predictor of operative risk [5], an overall frailty assessment should be relevant for patients with severe aortic stenosis referred to TAVI. The 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. Conclusions Besides 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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