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Association of comorbid burden with clinical outcomes after transcatheter aortic valve implantation

Mamas

Association of comorbid burden with clinical outcomes after transcatheter aortic valve implantation Thumbnail


Authors



Abstract

OBJECTIVES
To investigate the association of the CharlsonComorbidity Index (CCI) with clinical outcomes after transcatheter aortic valve implantation (TAVI).

BACKGROUND: Patients undergoing TAVI have high comorbid burden; however, there is limited evidence of its impact on clinical outcomes.

METHODS: Data from 1887 patients from the UK, Canada, Spain, Switzerland and Italy were collected between 2007 and 2016. The association of CCI with 30-day mortality, Valve Academic Research Consortium-2 (VARC-2) composite early safety, long-term survival and length of stay (LoS) was calculated using logistic regression and Cox proportional hazard models, as a whole cohort and at a country level, through a two-stage individual participant data (IPD) random effect meta-analysis.

RESULTS
Most (60%) of patients had a CCI =3. A weak correlation was found between the total CCI and four different preoperative risks scores (?=0.16?to 0.29), and approximately 50% of patients classed as low risk from four risk prediction models still presented with a CCI =3. Per-unit increases in total CCI were not associated with increased odds of 30-day mortality (OR 1.09, 95%?CI 0.96 to 1.24) or VARC-2 early safety (OR 1.04, 95%?CI 0.96 to 1.14) but were associated with increased hazard of long-term mortality (HR 1.10, 95%?CI 1.05 to 1.16). The two-stage IPD meta-analysis indicated that CCI was not associated with LoS (HR 0.97, 95%?CI 0.93 to 1.02).

CONCLUSION: In this multicentre international study, patients undergoing TAVI had significant comorbid burden. We found a weak correlation between the CCI and well-established preoperative risks scores. The CCI had a moderate association with long-term mortality up to 5?years post-TAVI.

Acceptance Date Jul 2, 2018
Publication Date Dec 1, 2018
Publicly Available Date Mar 29, 2024
Journal Heart
Print ISSN 1355-6037
Publisher BMJ Publishing Group
Pages 2058-2066
DOI https://doi.org/10.1136/heartjnl-2018-313356
Keywords aortic and arterial disease, aortic stenosis, epidemiology, transcatheter valve interventions
Publisher URL http://dx.doi.org/10.1136/heartjnl-2018-313356