Impact of frailty scores on outcome of octogenarian patients undergoing transcatheter aortic valve implantation
Impact of frailty scores on outcome of octogenarian patients undergoing transcatheter aortic valve implantation
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DOI：
10.1080/ac.68.6.8000007
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发表时间：
2013-12-01
影响因子：
1.6
通讯作者：
Kefer, Joelle
中科院分区：
文献类型：
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作者：
Kamga, Michele;Boland, Benoit;Kefer, Joelle
背景对于选定的症状性主动脉瓣狭窄患者，经导管主动脉瓣植入术（TAVI）是外科主动脉瓣置换术（AVR）的替代方案。除合并症外，在决策过程中还必须考虑虚弱。根据目前的指南，患者选择标准包括EuroSCORE和STS评分，但虚弱不容易量化。Isar（识别老年人风险）检测老年人在紧急访问和SHERPA后有不良健康结果的风险（评分Hospitalier d'Evaluation du Risque de Perte d'Autonomie）目的本研究的目的是评估ISAR和SHERPA评分对TAVI术后患者预后的影响。方法和结果在我们的机构中，连续的老年患者（16名男性，86 +/- 3岁，EuroSCORE 34 +/- 12%）接受了经股动脉TAVI和完整的老年评估。一年生存率为73%。两组的ISAR评分相似（3.1 +/- 1 vs. 3.6 +/- 1; P = 0.10），但非幸存者的SHERPA评分（7.8 +/- 1.6）显著高于幸存者（4.9 +/- 2.4; P = 0.001）。多因素分析显示，SHERPA评分和BMI是1年死亡率的独立预测因素。Kaplan-Meier分析显示SHERPA评分> 7分的患者1年生存率显著低于未评分者（40 vs. 89%; P = 0.004）。结论本研究结果表明，SHERPA评分可预测经股动脉TAVI术后1年生存率，可作为患者筛选的一个有用的虚弱评分。
Background For selected patients with symptomatic aortic stenosis, transcatheter aortic valve implantation (TAVI) is an alternative to surgical aortic valve replacement (AVR). In addition to co-morbidities, frailty has to be taken into account in the decision-making process. Criteria for patient selection, according to current guidelines, include EuroSCORE and STS score but frailty is not easy to quantify. ISAR (Identification of Seniors At Risk) detects seniors at risk for adverse health outcome after an emergency visit and SHERPA (Score Hospitalier d'Evaluation du Risque de Perte d'Autonomie) assesses the risk of functional decline after hospitalization.Objectives The aim of the present study was to evaluate the impact of ISAR and SHERPA scores in the prediction of patient outcome after TAVI.Methods and results A prospective cohort of 30 consecutive octogenarian patients (16 males, 86 +/- 3 y, EuroSCORE 34 +/- 12%) underwent a transfemoral TAVI and a complete geriatric assessment in our institution. Survival at one year was 73%. The ISAR score was similar between both groups (3.1 +/- 1 vs. 3.6 +/- 1; P = 0.10) but the SHERPA score was significantly higher in non-survivors (7.8 +/- 1.6) than among survivors (4.9 +/- 2.4; P = 0.001). With multivariate analysis, SHERPA score and BMI were independent predictors of 1-year mortality. Kaplan-Meier analysis showed that 1-year survival was significantly lower in patients with than in those without a SHERPA score > 7 (40 vs. 89%; P = 0.004).Conclusions The result of this study showed that SHERPA score predicts 1-year survival after transfemoral TAVI and could be considered as a useful frailty score in patient selection.