Author + information
- Received May 23, 2019
- Revision received July 31, 2019
- Accepted August 7, 2019
- Published online January 20, 2020.
- Soroosh Kiani, MD, MSa,∗∗ (, )@RooshMD,
- Amanda Stebbins, MPHb,
- Vinod H. Thourani, MDc,
- Jessica Forcillo, MDd,
- Sreekanth Vemulapalli, MDb,
- Andrzej S. Kosinski, PhDb,
- Vasilis Babaliaros, MDa,
- David Cohen, MDe,
- Susheel K. Kodali, MDf,
- Ajay J. Kirtane, MDf,
- James B. Hermiller Jr., MDg,
- James Stewart, MDa,
- Angela Lowenstern, MDb,
- Michael J. Mack, MDh,
- Robert A. Guyton, MDi,
- Chandan Devireddy, MDa,∗ (, )
- on behalf of the STS/ACC TVT Registry
- aDepartment of Medicine, Division of Cardiology, Emory University, Atlanta, Georgia
- bDuke Clinical Research Institute, Durham, North Carolina
- cMedStar Heart and Vascular Institute/Georgetown University, Washington, DC
- dDepartment of Cardiac Surgery, Université de Montréal, Montreal, Canada
- eDepartment of Internal Medicine, Section of Cardiovascular Disease, University of Missouri, Kansas City, Missouri
- fColumbia University Medical Center/NewYork-Presbyterian Hospital and the Cardiovascular Research Foundation, New York, New York
- gSt. Vincent Cardiovascular Research Institute, Indianapolis, Indiana
- hBaylor Scott & White Health, Plano, Texas
- iEmory University School of Medicine, Department of Surgery, Division of Cardiothoracic Surgery, Emory University, Atlanta, Georgia
Objectives This study sought to evaluate the ability of individual markers of frailty to predict outcomes after transcatheter aortic valve replacement (TAVR) and of their discriminatory value in different age groups.
Background Appropriate patient selection for TAVR remains a dilemma, especially among the most elderly and potentially frail.
Methods The study evaluated patients ≥65 years of age in the Society of Thoracic Surgeons/American College of Cardiology Transcatheter Valve Therapy registry, linked to Centers for Medicare and Medicaid administrative claims data, receiving elective TAVR from November 2011 to June 2016 (n = 36,242). Indices of frailty included anemia, albumin level, and 5-m walk speed. We performed Cox proportional hazards regression for 30-day and 1-year mortality, adjusting for risk factors known to be predictive of 30-day mortality in the Transcatheter Valve Therapy registry, as well as survival analysis.
Results These indices are independently associated with mortality at 30 days and 1 year and provide incremental value in risk stratification for mortality, with low albumin providing the largest value (hazard ratio: 1.52). Those with low albumin and slower walking speed had longer lengths of stay and higher rates of bleeding and readmission (p < 0.001). Those with anemia also had higher rates of bleeding, readmission, and subsequent myocardial infarction (p < 0.001).
Conclusions This represents the largest study to date of the role of frailty indices after TAVR, further facilitating robust modeling and adjusting for a large number of confounders. These simple indices are easily attainable, and clinically relevant markers of frailty that may meaningfully stratify patients at risk for mortality after TAVR.
Dr. Lowenstern was supported by National Institutes of Health T-32 training grant #5 T32 HL069749-14. Dr. Vemulapalli has received grant and contract support from Abbott Vascular, Boston Scientific, the Patient-Centered Outcomes Research Institute, the American College of Cardiology, the Society of Thoracic Surgeons, National Institutes of Health, and Food and Drug Administration (National Evaluation System for Health Technology); and has served on the advisory board or as a consultant for Boston Scientific, Janssen, Premiere, and Zafgen. Dr. Babaliaros owns equity in Transmural Systems; and has served as a consultant for Edwards Lifesciences and Abbott Vascular. Dr. Cohen has served as a consultant for Edwards Lifesciences, Medtronic, and Boston Scientific; and has received research grant support from Edwards Lifesciences, Medtronic, Boston Scientific, and Abbott. Dr. Kodali has served as a consultant for and received honoraria from Meril Lifesciences, Admedus, Claret Medical, and Abbott Vascular; has served on the scientific advisory board for Dura Biotech, Thubrikar Aortic Valve, and Microinterventional Devices; and owns equity in Dura Biotech, Thubrikar Aortic Valve, Microinterventional Devices, and BioTrace Medical. Dr. Kirtane has received institutional research grant support to Columbia University and/or the Cardiovascular Research Foundation from Medtronic, Boston Scientific, Abbott Vascular, Abiomed, Cardiovascular Systems Inc., CathWorks, Siemens AG, Philips, and ReCor Medical. Dr. Hermiller has served as a consultant for Edwards Lifesciences and Medtronic. Dr. Mack is an uncompensated co-principle investigator for clinical trials sponsored by Edwards Lifesciences, Medtronic, Abbott, and Gore. Dr. Guyton has served as a consultant for Edwards Lifesciences. Dr. Devireddy has served on the Data Safety Monitoring Board for Medtronic; is on the scientific advisory board for Vascular Dynamics Inc., Shockwave Medical, and ReCor Medical; and served as a consultant for Medtronic and Shockwave Medical. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received May 23, 2019.
- Revision received July 31, 2019.
- Accepted August 7, 2019.
- 2020 American College of Cardiology Foundation
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