Clinical Research in Cardiology

, Volume 103, Issue 8, pp 631–640 | Cite as

Development of a risk score for outcome after transcatheter aortic valve implantation

  • Moritz Seiffert
  • Jan-Malte Sinning
  • Alexander Meyer
  • Sandra Wilde
  • Lenard Conradi
  • Mariuca Vasa-Nicotera
  • Alexander Ghanem
  • Jörg Kempfert
  • Christoph Hammerstingl
  • Francisco M. Ojeda
  • Won-Keun Kim
  • Dietmar H. Koschyk
  • Johannes Schirmer
  • Stephan Baldus
  • Eberhard Grube
  • Helge Möllmann
  • Hermann Reichenspurner
  • Georg Nickenig
  • Stefan Blankenberg
  • Patrick Diemert
  • Hendrik Treede
  • Thomas Walther
  • Nikos Werner
  • Renate B. Schnabel
Original Paper

Abstract

Aims

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.

Methods

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 ± 6.5, 51 % women. Clinical variables were determined at baseline. Multivariable Cox regression related clinical data to mortality (n = 207 deaths).

Results

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 χ2-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 χ2-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.

Conclusions

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.

Keywords

TAVI Risk factors Valves Cohort Mortality Frailty 

Abbreviations

BMI

Body mass index

CI

Confidence Interval

eGFR

Estimated glomerular filtration rate

GARY

German aortic valve registry

NRI

Net reclassification improvement

NYHA

New York heart association

TAVI

Transcatheter aortic valve implantation

Notes

Acknowledgments

We thank the participants and staff for their dedication. This work was supported by Emmy Noether Program SCHN 1149/3-1 to R.B.S.

Conflict of interest

The authors report no conflicts of interest.

Supplementary material

392_2014_692_MOESM1_ESM.docx (55 kb)
Supplementary material 1 (DOCX 55 kb)

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Copyright information

© Springer-Verlag Berlin Heidelberg 2014

Authors and Affiliations

  • Moritz Seiffert
    • 1
  • Jan-Malte Sinning
    • 2
  • Alexander Meyer
    • 4
  • Sandra Wilde
    • 1
  • Lenard Conradi
    • 5
  • Mariuca Vasa-Nicotera
    • 2
  • Alexander Ghanem
    • 2
  • Jörg Kempfert
    • 4
  • Christoph Hammerstingl
    • 2
  • Francisco M. Ojeda
    • 1
  • Won-Keun Kim
    • 4
    • 6
  • Dietmar H. Koschyk
    • 1
  • Johannes Schirmer
    • 5
  • Stephan Baldus
    • 3
  • Eberhard Grube
    • 2
  • Helge Möllmann
    • 6
  • Hermann Reichenspurner
    • 5
  • Georg Nickenig
    • 2
  • Stefan Blankenberg
    • 1
  • Patrick Diemert
    • 1
  • Hendrik Treede
    • 5
  • Thomas Walther
    • 4
  • Nikos Werner
    • 2
  • Renate B. Schnabel
    • 1
  1. 1.Department of General and Interventional CardiologyUniversity Heart Center Hamburg-EppendorfHamburgGermany
  2. 2.Heart Center BonnUniversity Hospital BonnBonnGermany
  3. 3.Department of Cardiology, Pulmonology, Angiology and Intensive Care MedicineUniversity Heart Center CologneCologneGermany
  4. 4.Department of Cardiac SurgeryKerckhoff Clinic Bad NauheimBad NauheimGermany
  5. 5.Department of Cardiovascular SurgeryUniversity Heart Center Hamburg-EppendorfHamburgGermany
  6. 6.Department of CardiologyKerckhoff Clinic Bad NauheimBad NauheimGermany

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