Improvement of Risk Prediction After Transcatheter Aortic Valve Replacement by Combining Frailty With Conventional Risk Scores.

Abstract

OBJECTIVES:

This study sought to evaluate whether frailty improves mortality prediction in combination with the conventional scores.

BACKGROUND:

European System for Cardiac Operative Risk Evaluation (EuroSCORE) or Society of Thoracic Surgeons (STS) score have not been evaluated in combined models with frailty for mortality prediction after transcatheter aortic valve replacement (TAVR).

METHODS:

This prospective cohort comprised 330 consecutive TAVR patients ≥70 years of age. Conventional scores and a frailty index (based on assessment of cognition, mobility, nutrition, and activities of daily living) were evaluated to predict 1-year all-cause mortality using Cox proportional hazards regression (providing hazard ratios [HRs] with confidence intervals [CIs]) and measures of test performance (providing likelihood ratio [LR] chi-square test statistic and C-statistic [CS]).

RESULTS:

All risk scores were predictive of the outcome (EuroSCORE, HR: 1.90 [95% CI: 1.45 to 2.48], LR chi-square test statistic 19.29, C-statistic 0.67; STS score, HR: 1.51 [95% CI: 1.21 to 1.88], LR chi-square test statistic 11.05, C-statistic 0.64; frailty index, HR: 3.29 [95% CI: 1.98 to 5.47], LR chi-square test statistic 22.28, C-statistic 0.66). A combination of the frailty index with either EuroSCORE (LR chi-square test statistic 38.27, C-statistic 0.72) or STS score (LR chi-square test statistic 28.71, C-statistic 0.68) improved mortality prediction. The frailty index accounted for 58.2% and 77.6% of the predictive information in the combined model with EuroSCORE and STS score, respectively. Net reclassification improvement and integrated discrimination improvement confirmed that the added frailty index improved risk prediction.

CONCLUSIONS:

This is the first study showing that the assessment of frailty significantly enhances prediction of 1-year mortality after TAVR in combined risk models with conventional risk scores and relevantly contributes to this improvement.

• Authors: Andreas W Schoenenberger, André Moser, Dominic Bertschi, Peter Wenaweser, Stephan Windecker, Thierry Carrel, Andreas E Stuck, Stefan Stortecky
• Journal: JACC. Cardiovascular interventions (JACC Cardiovasc Interv) Vol. 11 Issue 4 Pg. 395-403 (02 26 2018) ISSN: 1876-7605 [Electronic] United States
• PMID: 29471953 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)
• Copyright: Copyright © 2018 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

Topics

• Activities of Daily Living
• Age Factors
• Aged
• Aortic Valve Stenosis (complications, diagnosis, mortality, surgery)
• Chi-Square Distribution
• Clinical Decision-Making
• Cognition
• Decision Support Techniques
• Female
• Frail Elderly
• Frailty (complications, diagnosis, mortality, psychology)
• Geriatric Assessment
• Humans
• Male
• Mobility Limitation
• Nutrition Assessment
• Nutritional Status
• Patient Selection
• Predictive Value of Tests
• Proportional Hazards Models
• Prospective Studies
• Risk Assessment
• Risk Factors
• Severity of Illness Index
• Transcatheter Aortic Valve Replacement (adverse effects, instrumentation, mortality)