Universität zu Köln

Seiffert, Moritz, Sinning, Jan-Malte, Meyer, Alexander ORCID: 0000-0002-6944-2478, Wilde, Sandra, Conradi, Lenard, Vasa-Nicotera, Mariuca, Ghanem, Alexander, Kempfert, Joerg, Hammerstingl, Christoph, Ojeda, Francisco M., Kim, Won-Keun ORCID: 0000-0002-0799-7478, Koschyk, Dietmar H., Schirmer, Johannes, Baldus, Stephan, Grube, Eberhard, Moellmann, Helge, Reichenspurner, Hermann, Nickenig, Georg, Blankenberg, Stefan, Diemert, Patrick, Treede, Hendrik, Walther, Thomas, Werner, Nikos and Schnabel, Renate B. (2014). Development of a risk score for outcome after transcatheter aortic valve implantation. Clin. Res. Cardiol., 103 (8). S. 631 - 641. HEIDELBERG: SPRINGER HEIDELBERG. ISSN 1861-0692

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Abstract

Transcatheter aortic valve implantation (TAVI) is an increasingly common procedure in elderly and multimorbid patients with aortic stenosis. We aimed at developing a pre-procedural risk evaluation scheme beyond current surgical risk scores. We developed a risk algorithm for 1-year mortality in two cohorts consisting of 845 patients undergoing routine TAVI procedures by commercially available devices, mean age 80.9 +/- A 6.5, 51 % women. Clinical variables were determined at baseline. Multivariable Cox regression related clinical data to mortality (n = 207 deaths). To account for variability related to age and sex and by enrolment site we forced age, sex, and cohort into the score model. Body mass index, estimated glomerular filtration rate, hemoglobin, pulmonary hypertension, mean transvalvular gradient and left ventricular ejection fraction at baseline were most strongly associated with mortality and entered the risk prediction algorithm [C-statistic 0.66, 95 % confidence interval (CI) 0.61-0.70, calibration chi (2)-statistic = 6.51; P = 0.69]. Net reclassification improvement compared to existing surgical risk predication schemes was positive. The score showed reasonable model fit and calibration in external validation in 333 patients, N = 55 deaths (C-statistic 0.60, 95 % CI 0.52-0.68; calibration chi (2)-statistic = 16.2; P = 0.06). Additional measurement of B-type natriuretic peptide and troponin I did not improve the C-statistic. Frailty increased the C-statistic to 0.71, 95 % CI 0.65-0.76. We present a new risk evaluation tool derived and validated in routine TAVI cohorts that predicts 1-year mortality. Biomarkers only marginally improved risk prediction. Frailty increased the discriminatory ability of the score and needs to be considered. Risk algorithms specific for TAVI may help to guide decision-making when patients are evaluated for TAVI.

Item Type:	Journal Article
Creators:	Creators Email ORCID ORCID Put Code Seiffert, Moritz UNSPECIFIED UNSPECIFIED UNSPECIFIED Sinning, Jan-Malte UNSPECIFIED UNSPECIFIED UNSPECIFIED Meyer, Alexander UNSPECIFIED orcid.org/0000-0002-6944-2478 UNSPECIFIED Wilde, Sandra UNSPECIFIED UNSPECIFIED UNSPECIFIED Conradi, Lenard UNSPECIFIED UNSPECIFIED UNSPECIFIED Vasa-Nicotera, Mariuca UNSPECIFIED UNSPECIFIED UNSPECIFIED Ghanem, Alexander UNSPECIFIED UNSPECIFIED UNSPECIFIED Kempfert, Joerg UNSPECIFIED UNSPECIFIED UNSPECIFIED Hammerstingl, Christoph UNSPECIFIED UNSPECIFIED UNSPECIFIED Ojeda, Francisco M. UNSPECIFIED UNSPECIFIED UNSPECIFIED Kim, Won-Keun UNSPECIFIED orcid.org/0000-0002-0799-7478 UNSPECIFIED Koschyk, Dietmar H. UNSPECIFIED UNSPECIFIED UNSPECIFIED Schirmer, Johannes UNSPECIFIED UNSPECIFIED UNSPECIFIED Baldus, Stephan UNSPECIFIED UNSPECIFIED UNSPECIFIED Grube, Eberhard UNSPECIFIED UNSPECIFIED UNSPECIFIED Moellmann, Helge UNSPECIFIED UNSPECIFIED UNSPECIFIED Reichenspurner, Hermann UNSPECIFIED UNSPECIFIED UNSPECIFIED Nickenig, Georg UNSPECIFIED UNSPECIFIED UNSPECIFIED Blankenberg, Stefan UNSPECIFIED UNSPECIFIED UNSPECIFIED Diemert, Patrick UNSPECIFIED UNSPECIFIED UNSPECIFIED Treede, Hendrik UNSPECIFIED UNSPECIFIED UNSPECIFIED Walther, Thomas UNSPECIFIED UNSPECIFIED UNSPECIFIED Werner, Nikos UNSPECIFIED UNSPECIFIED UNSPECIFIED Schnabel, Renate B. UNSPECIFIED UNSPECIFIED UNSPECIFIED
URN:	urn:nbn:de:hbz:38-433003
DOI:	10.1007/s00392-014-0692-4
Journal or Publication Title:	Clin. Res. Cardiol.
Volume:	103
Number:	8
Page Range:	S. 631 - 641
Date:	2014
Publisher:	SPRINGER HEIDELBERG
Place of Publication:	HEIDELBERG
ISSN:	1861-0692
Language:	English
Faculty:	Unspecified
Divisions:	Unspecified
Subjects:	no entry
Uncontrolled Keywords:	Keywords Language ACADEMIC RESEARCH CONSORTIUM; PROGNOSTIC VALUE; MYOCARDIAL INJURY; NATRIURETIC PEPTIDE; CLINICAL-OUTCOMES; CARDIAC-SURGERY; STENOSIS; REPLACEMENT; PREDICTORS; REGISTRY Multiple languages Cardiac & Cardiovascular Systems Multiple languages
URI:	http://kups.ub.uni-koeln.de/id/eprint/43300