Author + information
- Received September 9, 2011
- Revision received January 27, 2012
- Accepted February 1, 2012
- Published online May 1, 2012.
- Stefan Stortecky, MD⁎,
- Andreas W. Schoenenberger, MD†,
- André Moser, PhD‡,
- Bindu Kalesan, PhD‡,
- Peter Jüni, MD‡,
- Thierry Carrel, MD§,
- Seraina Bischoff, RN⁎,
- Christa-Maria Schoenenberger, RN⁎,
- Andreas E. Stuck, MD†,
- Stephan Windecker, MD⁎,⁎ ( and )
- Peter Wenaweser, MD⁎
- ↵⁎Reprint requests and correspondence:
Dr. Stephan Windecker, Department of Cardiology, Swiss Cardiovascular Center Bern, Bern University Hospital, Freiburgstrasse, 3010 Bern, Switzerland
Objectives This study evaluated Multidimensional Geriatric Assessment (MGA) as predictor of mortality and major adverse cardiovascular and cerebral events (MACCE) after transcatheter aortic valve implantation (TAVI).
Background Currently used global risk scores do not reliably estimate mortality and MACCE in these patients.
Methods This prospective cohort comprised 100 consecutive patients ≥70 years undergoing TAVI. Global risk scores (Society of Thoracic Surgeons [STS] score, EuroSCORE) and MGA-based scores (cognition, nutrition, mobility, activities of daily living [ADL], and frailty index) were evaluated as predictors of all-cause mortality and MACCE 30 days and 1 year after TAVI in regression models.
Results In univariable analyses, all predictors were significantly associated with mortality and MACCE at 30 days and 1 year, except for the EuroSCORE at 30 days and instrumental ADL at 30 days and 1 year. Associations of cognitive impairment (odds ratio [OR]: 2.98, 95% confidence interval [CI]: 1.07 to 8.31), malnutrition (OR: 6.72, 95% CI: 2.04 to 22.17), mobility impairment (OR: 6.65, 95% CI: 2.15 to 20.52), limitations in basic ADL (OR: 3.63, 95% CI: 1.29 to 10.23), and frailty index (OR: 3.68, 95% CI: 1.21 to 11.19) with 1-year mortality were similar compared with STS score (OR: 5.47, 95% CI: 1.48 to 20.22) and EuroSCORE (OR: 4.02, 95% CI: 0.86 to 18.70). Similar results were found for 30-day mortality and MACCE. Bivariable analyses, including STS score or EuroSCORE suggested independent associations of MGA-based scores (e.g., OR of frailty index: 3.29, 95% CI: 1.06 to 10.15, for 1-year mortality in a model including EuroSCORE).
Conclusions This study provides evidence that risk prediction can be improved by adding MGA-based information to global risk scores. Larger studies are needed for the development and validation of improved risk prediction models.
This study was supported by research grants from Bern University Hospital and a grant of the Swiss National Science Foundation to Dr. Windecker (SNF Grant 32003B_135807). Dr. Jüni is an unpaid member of steering group or executive committee of trials funded by Abbott Vascular, Biosensors, Medtronic, and St. Jude Medical. Dr. Windecker received lecture and consulting fees from Medtronic and Edwards Lifesciences. Dr. Wenaweser is a proctor for Medtronic CoreValve and Edwards Lifesciences; and he received honoraria from Medtronic and Edwards Lifesciences. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose. Drs. Stortecky and Schoenenbeger contributed equally to this work. Peter Block, MD, served as a Guest Editor for this paper.
- Received September 9, 2011.
- Revision received January 27, 2012.
- Accepted February 1, 2012.
- 2012 American College of Cardiology Foundation