Patient risk evaluation for transcatheter aortic valve replacement (PRE-TAVR) - identification of real-time predictors of short- and long-term mortality.
Julian Kreutz, Philipp Lauten, Georgios Chatzis, Marie Nabrotzki, Nikolaos Patsalis, Styliani Syntila, Harald Lapp, Bernhard Schieffer, Birgit Markus
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引用次数: 0
Abstract
Background: The steadily increasing number of transcatheter aortic valve replacement (TAVR) procedures being performed on a heterogeneous patient population highlights the need for robust risk assessment. While EuroSCORE II is well established for surgical risks, it is less effective for TAVR, and the newer STS/ACC TAVR score has so far been validated mainly for in-hospital and 30-day mortality.
Aims: This study aims to improve risk stratification for TAVR patients by identifying real-time predictors of 30-day and 1-year mortality that incorporate comprehensive, procedure-specific factors.
Methods: Five-year data from 2256 transfemoral TAVR procedures performed at two German Heart Centers (2017-2022) were retrospectively analyzed. Predictors of 1-year and 30-day mortality were assessed using multivariable logistic and LASSO regression, considering a broad spectrum of patient demographics, comorbidities, and peri-procedural factors.
Results: The analyses revealed a predictor model (PRE-TAVR predictors) for 1-year mortality (AUC 0.770; 95% CI 0.731-0.809), including age (> 81.5 years), NYHA stage IV, COPD (GOLD ≥ 2), atrial fibrillation, previous stroke or malignancy, elevated C-reactive protein (≥ 9.5 mg/L), aortic valve ΔP mean ≥ 48.5 mmHg, peripheral arterial disease (> stage 2) and low platelet count (≤ 228.5 g/L). The accuracy of the model exceeded the EuroSCORE II (AUC 0.645; 95% CI 0.599-0.691) and the STS/ACC TAVR score (AUC 0.714; 95% CI 0.670-0.758). For 30-day mortality, NYHA class IV was the only significant predictor in the bivariate analyses. However, additional LASSO analyses identified pre-existing renal insufficiency (KDIGO stage ≥ 3) and pre-TAVR sodium levels as further significant predictors. The AUC was 0.699 (95% CI 0.611-0.788) compared to an AUC of 0.680 (95% CI 0.604-0.756) for EuroSCORE II and 0.7129 (95% CI 0.633-0.793) for the STS/ACC TAVR score.
Conclusion: The PRE-TAVR study developed a robust model, particularly for predicting 1-year mortality. This model outperformed the EuroSCORE II and STS/ACC TAVR scores, despite requiring fewer variables. It provides a solid basis for future risk scores and enables more precise patient selection.
背景:在异质患者群体中,经导管主动脉瓣置换术(TAVR)的数量稳步增加,这凸显了对可靠风险评估的需求。虽然EuroSCORE II在手术风险方面得到了很好的证实,但对TAVR的疗效较差,而较新的STS/ACC TAVR评分迄今为止主要用于住院和30天死亡率。目的:本研究旨在通过识别综合的、手术特异性因素的30天和1年死亡率的实时预测指标,改善TAVR患者的风险分层。方法:回顾性分析两家德国心脏中心(2017-2022)2256例经股TAVR手术的5年数据。考虑到广泛的患者人口统计学、合并症和围手术期因素,使用多变量logistic和LASSO回归评估1年和30天死亡率的预测因子。结果:分析揭示了1年死亡率的预测模型(PRE-TAVR预测因子)(AUC 0.770;95% CI 0.731-0.809),包括年龄(> 81.5岁)、NYHA期、COPD (GOLD≥2)、房颤、既往卒中或恶性肿瘤、c反应蛋白升高(≥9.5 mg/L)、主动脉瓣ΔP平均≥48.5 mmHg、外周动脉疾病(>期2)和血小板计数低(≤228.5 g/L)。模型的精度超过EuroSCORE II (AUC为0.645;95% CI 0.599-0.691)和STS/ACC TAVR评分(AUC 0.714;95% ci 0.670-0.758)。对于30天死亡率,NYHA IV级是双变量分析中唯一显著的预测因子。然而,进一步的LASSO分析发现,预先存在的肾功能不全(KDIGO期≥3)和tavr前的钠水平是进一步的重要预测因素。AUC为0.699 (95% CI 0.611-0.788),而EuroSCORE II的AUC为0.680 (95% CI 0.604-0.756), STS/ACC TAVR评分的AUC为0.7129 (95% CI 0.633-0.793)。结论:PRE-TAVR研究建立了一个稳健的模型,特别是在预测1年死亡率方面。该模型优于EuroSCORE II和STS/ACC TAVR评分,尽管需要更少的变量。它为未来的风险评分提供了坚实的基础,并使患者选择更加精确。
期刊介绍:
Clinical Research in Cardiology is an international journal for clinical cardiovascular research. It provides a forum for original and review articles as well as critical perspective articles. Articles are only accepted if they meet stringent scientific standards and have undergone peer review. The journal regularly receives articles from the field of clinical cardiology, angiology, as well as heart and vascular surgery.
As the official journal of the German Cardiac Society, it gives a current and competent survey on the diagnosis and therapy of heart and vascular diseases.