Bagur, R, Martin, GP, Nombela-Franco, L, Doshi, SN, George, S, Toggweiler, S, Sponga, S, Cotton, JM, Khogali, SS, Ratib, K, Kinnaird, T, Anderson, RA, Chu, MWA, Kiaii, B, Biagioni, C, Schofield-Kelly, L, Loretz, L, Torracchi, L, Sekar, B, Kwok, CS, Sperrin, M, Ludman, PF and Mamas, MA (2018) Association of comorbid burden with clinical outcomes after transcatheter aortic valve implantation. Heart, 104 (24). pp. 2058-2066. ISSN 1468-201X

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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.

Most (60%) of patients had a CCI ≥3. A weak correlation was found between the total CCI and four different preoperative risks scores (ρ=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.

Item Type: Article
Additional Information: This is the accepted author manuscript (AAM). The final published version (version of record) is available online via BMJ Publishing Group at - please refer to any applicable terms of use of the publisher.
Uncontrolled Keywords: aortic and arterial disease, aortic stenosis, epidemiology, transcatheter valve interventions
Subjects: R Medicine > RC Internal medicine > RC666 Diseases of the circulatory (Cardiovascular) system
Divisions: Faculty of Medicine and Health Sciences > Institute for Science and Technology in Medicine
Related URLs:
Depositing User: Symplectic
Date Deposited: 13 Sep 2018 15:59
Last Modified: 08 Jan 2019 14:32

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