Mamas Mamas m.mamas@keele.ac.uk
Association of comorbid burden with clinical outcomes after transcatheter aortic valve implantation
Mamas
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 |
Files
_system_appendPDF_proof_hi.pdf
(2 Mb)
PDF
Publisher Licence URL
https://creativecommons.org/licenses/by-nc/4.0/
You might also like
Downloadable Citations
About Keele Repository
Administrator e-mail: research.openaccess@keele.ac.uk
This application uses the following open-source libraries:
SheetJS Community Edition
Apache License Version 2.0 (http://www.apache.org/licenses/)
PDF.js
Apache License Version 2.0 (http://www.apache.org/licenses/)
Font Awesome
SIL OFL 1.1 (http://scripts.sil.org/OFL)
MIT License (http://opensource.org/licenses/mit-license.html)
CC BY 3.0 ( http://creativecommons.org/licenses/by/3.0/)
Powered by Worktribe © 2024
Advanced Search