Impact of the Clinical Frailty Scale on Outcomes After Transcatheter Aortic Valve Replacement
Impact of the Clinical Frailty Scale on Outcomes After Transcatheter Aortic Valve Replacement
复制标题
DOI：
10.1161/circulationaha.116.025630
复制
发表时间：
2017-05-23
期刊：
影响因子：
37.8
通讯作者：
Hayashida, Kentaro
中科院分区：
文献类型：
--
作者：
Shimura, Tetsuro;Yamamoto, Masanori;Hayashida, Kentaro
背景技术背景：半定量临床虚弱量表（CFS）是评估患者虚弱程度的简单工具，已被证明与老年患者的死亡率相关，即使由非老年科医生评估。本研究的目的是确定CFS在接受经导管主动脉瓣置换术的患者中的预后价值。方法：我们利用OCEAN（优化导管瓣膜介入）日本多中心注册表回顾了1215例接受经导管主动脉瓣置换术的患者的数据。根据CFS分期将患者分为5组：CFS 1-3、CFS 4、CFS 5、CFS 6和CFS >= 7。我们随后评估了CFS分级与其他虚弱指标之间的关系，包括体重指数、血清白蛋白、步态速度和平均握力。我们还评估了基线特征，手术结果，早期和中期死亡率之间的差异5 groups.RESULTS：患者分布到5 CFS组如下：38.0%（CFS 1-3），32.9%（CFS 4），15.1%（CFS 5），10.0%（CFS 6），和4.0%（CFS >= 7）。CFS分级与体重指数（斯皮尔曼rho=-0.077，P= 0.007）、白蛋白（rho=-0.22，P < 0.001）、步行速度（rho=-0.28，P < 0.001）和握力（rho=-0.26，P < 0.001）显著相关。累积1年死亡率随CFS分期的增加而增加（7.2%，8.6%）。15.7%，16.9%，44.1%，P < 0.001）。在考克斯回归多变量分析中，CFS（每增加1个类别）是晚期累积死亡风险增加的独立预测因素（风险比，1.28; 95%可信区间，1.10-.49; P < 0.001）。除了反映虚弱程度外，CFS是预测老年经导管主动脉瓣置换术队列中晚期死亡率的有用指标。
BACKGROUND: The semiquantitative Clinical Frailty Scale (CFS) is a simple tool to assess patients' frailty and has been shown to correlate with mortality in elderly patients even when evaluated by nongeriatricians. The aim of the current study was to determine the prognostic value of CFS in patients who underwent transcatheter aortic valve replacement.METHODS: We utilized the OCEAN (Optimized Catheter Valvular Intervention) Japanese multicenter registry to review data of 1215 patients who underwent transcatheter aortic valve replacement. Patients were categorized into 5 groups based on the CFS stages: CFS 1-3, CFS 4, CFS 5, CFS 6, and CFS >= 7. We subsequently evaluated the relationship between CFS grading and other indicators of frailty, including body mass index, serum albumin, gait speed, and mean hand grip. We also assessed differences in baseline characteristics, procedural outcomes, and early and midterm mortality among the 5 groups.RESULTS: Patient distribution into the 5 CFS groups was as follows: 38.0% (CFS 1-3), 32.9% (CFS4), 15.1% (CFS 5), 10.0% (CFS 6), and 4.0% (CFS >= 7). The CFS grade showed significant correlation with body mass index (Spearman's rho= -0.077, P= 0.007), albumin (rho= -0.22, P < 0.001), gait speed (rho=-0.28, P < 0.001), and grip strength (rho=-0.26, P < 0.001). Cumulative 1- year mortality increased with increasing CFS stage (7.2%, 8.6%. 15.7%, 16.9%, 44.1%, P < 0.001). In a Cox regression multivariate analysis, the CFS (per 1 category increase) was an independent predictive factor of increased late cumulative mortality risk (hazard ratio, 1.28; 95% confidence interval, 1.10-.49; P < 0.001).CONCLUSIONS: In addition to reflecting the degree of frailty, the CFS was a useful marker for predicting late mortality in an elderly transcatheter aortic valve replacement cohort.