Author + information
- Received January 14, 2013
- Accepted February 2, 2013
- Published online May 1, 2013.
- Oliver Husser, MD⁎,†,
- Julio Núñez, MD‡,
- Eduardo Núñez, MD‡,
- Andreas Holzamer, MD§,
- Daniele Camboni, MD§,
- Andreas Luchner, MD⁎,
- Juan Sanchis, MD‡,
- Vicente Bodi, MD‡,
- Günter A.J. Riegger, MD⁎,
- Christof Schmid, MD§,
- Michael Hilker, MD§,⁎ ( and )
- Christian Hengstenberg, MD⁎,†,⁎ ()
- ↵⁎Reprint requests and correspondence:
Prof. Dr. Christian Hengstenberg, Klinik für Herz- und Kreislauferkrankungen, Deutsches Herzzentrum München, Munich, Germany
- ↵⁎Prof. Dr. Michael Hilker, Klinik für Herz-, Thorax-, und herznahe Gefässchirurgie, University of Regensburg Medical Center, Franz-Josef-Strauss-Allee 1193053, Regensburg, Germany
Objectives This study sought to predict the value of tumor marker carbohydrate antigen 125 (CA125) before and after transcatheter aortic valve implantation (TAVI) for all-cause death and a composite endpoint of death, admission for heart failure, myocardial infarction, and stroke (major adverse cardiac events [MACE]).
Background Risk stratification after TAVI remains challenging. The use of biomarkers in this setting represents an unmet need.
Methods CA125 was measured in 228 patients before and after TAVI. The association with outcomes was assessed using parametric Cox regression and joint modeling for baseline and longitudinal analyses, respectively. CA125 was evaluated as logarithm transformation and dichotomized by its median value (M1 ≤15.7 U/ml vs. M2 >15.7 U/ml).
Results At a median follow-up of 183 days (interquartile range: 63 to 365) and 144 days (interquartile range: 56 to 365), 50 patients (22%) died and 75 patients (33%) experienced MACE. A 3-fold increase in the rates for death and MACE was observed in patients above the median (M2 vs. M1) of CA125 (5.2 vs. 1.6 per 10 person-years and 8.3 vs. 3.3 per 10 person-years, respectively; p for both <0.001). In a multivariable analysis adjusted for logistic EuroSCORE, New York Heart Association functional class III/IV, and device success, baseline values of CA125 (M2 vs. M1) independently predicted death (hazard ratio [HR]: 2.18; 95% confidence interval [CI]: 1.11 to 4.26; p = 0.023) and MACE (HR: 1.77; 95% CI: 1.05 to 2.98; p = 0.031). In the longitudinal analysis, lnCA125 as a time-varying exposure, was highly associated with both endpoints: HR: 1.47; 95% CI: 1.01 to 2.14; p = 0.043 and HR: 2.26; 95% CI: 1.28 to 3.98; p = 0.005, for death and MACE, respectively.
Conclusions Serum levels of CA125 before and after TAVI independently predict death and MACE.
Drs. Sanchis and Núñez were supported by the Instituto de Salud Carlos III (FEDER), Red HERACLES, Ministry of Health, Madrid. Dr. Bodi was supported by the grant PI1102323. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose. Dr. Husser and Dr. Nunez contributed equally to this work. Prof. Drs. Hilker and Hengstenberg are joint senior authors of this work.
- Received January 14, 2013.
- Accepted February 2, 2013.
- American College of Cardiology Foundation