The Effect and Relationship of Frailty Indices on Survival After Transcatheter Aortic Valve Replacement
The Effect and Relationship of Frailty Indices on Survival After Transcatheter Aortic Valve Replacement
复制标题
DOI：
10.1016/j.jcin.2019.08.015
复制
发表时间：
2020-01-27
影响因子：
11.3
通讯作者：
Devireddy, Chandan
中科院分区：
文献类型：
--
作者：
Kiani, Soroosh;Stebbins, Amanda;Devireddy, Chandan
本研究旨在评估个体虚弱标志物预测经导管主动脉瓣置换术（TAVR）后结果的能力及其在不同年龄组中的区分价值。特别是在大多数老年人和潜在的体弱者中。美国心脏病学院经导管瓣膜治疗登记处，与医疗保险和医疗补助中心行政索赔数据相关，于2011年11月至2016年6月接受了选择性TAVR（n = 36，242）。虚弱指数包括贫血、白蛋白水平和5米步行速度。我们对30天和1年死亡率进行了考克斯比例风险回归，调整了经导管瓣膜治疗登记处中已知可预测30天死亡率的风险因素，以及生存分析。低白蛋白提供最大值（风险比：1.52）。白蛋白低、步行速度较慢的患者住院时间较长，出血率和再入院率较高（p < 0.001）。贫血患者的出血率、再入院率和随后的心肌梗死率也较高（p < 0.001）。结论：这是迄今为止关于TAVR后虚弱指数作用的最大规模研究，进一步促进了稳健的建模和对大量混杂因素的调整。这些简单的指标很容易获得，并且临床相关的虚弱标志物可以对TAVR后死亡风险患者进行有意义的分层。(C)2020年由美国心脏病学会基金会。
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. (C) 2020 by the American College of Cardiology Foundation.