Department of Medicine, Columbia University Medical Center, New York, New York 10032, USA.
JACC Cardiovasc Interv. 2012 Sep;5(9):974-81. doi: 10.1016/j.jcin.2012.06.011.
This study sought to evaluate the impact of frailty in older adults undergoing transcatheter aortic valve replacement (TAVR) for symptomatic aortic stenosis.
Frailty status impacts prognosis in older adults with heart disease; however, the impact of frailty on prognosis after TAVR is unknown.
Gait speed, grip strength, serum albumin, and activities of daily living status were collected at baseline and used to derive a frailty score among patients who underwent TAVR procedures at a single large-volume institution. The cohort was dichotomized on the basis of median frailty score into frail and not frail groups. The impact of frailty on procedural outcomes (stroke, bleeding, vascular complications, acute kidney injury, and mortality at 30 days) and 1-year mortality was evaluated.
Frailty status was assessed in 159 subjects who underwent TAVR (age 86 ± 8 years, Society of Thoracic Surgery Risk Score 12 ± 4). Baseline frailty score was not associated with conventionally ascertained clinical variables or Society of Thoracic Surgery score. Although high frailty score was associated with a longer post-TAVR hospital stay when compared with lower frailty score (9 ± 6 days vs. 6 ± 5 days, respectively, p = 0.004), there were no significant crude associations between frailty status and procedural outcomes, suggesting adequacy of the standard selection process for identifying patients at risk for periprocedural complications after TAVR. Frailty status was independently associated with increased 1-year mortality (hazard ratio: 3.5, 95% confidence interval: 1.4 to 8.5, p = 0.007) after TAVR.
Frailty was not associated with increased periprocedural complications in patients selected as candidates to undergo TAVR but was associated with increased 1-year mortality after TAVR. Further studies will evaluate the independent value of this frailty composite in older adults with aortic stenosis.
本研究旨在评估老年患者接受经导管主动脉瓣置换术（TAVR）治疗症状性主动脉瓣狭窄时衰弱的影响。
衰弱状况影响老年心脏病患者的预后；然而，衰弱对 TAVR 后预后的影响尚不清楚。
在一家大型单中心机构接受 TAVR 手术的患者在基线时收集步态速度、握力、血清白蛋白和日常生活活动状态，并用于得出衰弱评分。根据中位数衰弱评分将队列分为衰弱组和非衰弱组。评估衰弱对手术结果（中风、出血、血管并发症、急性肾损伤和 30 天死亡率）和 1 年死亡率的影响。
对 159 名接受 TAVR（年龄 86 ± 8 岁，胸外科医师协会风险评分 12 ± 4）的患者进行了衰弱状况评估。基线衰弱评分与传统确定的临床变量或胸外科医师协会评分无关。尽管与较低的衰弱评分相比，高衰弱评分与 TAVR 后住院时间较长相关（分别为 9 ± 6 天和 6 ± 5 天，p = 0.004），但衰弱状况与手术结果之间没有显著的粗关联，这表明 TAVR 后识别围手术期并发症风险患者的标准选择过程是充分的。衰弱状况与 TAVR 后 1 年死亡率增加独立相关（风险比：3.5，95%置信区间：1.4 至 8.5，p = 0.007）。
在选择接受 TAVR 的患者中，衰弱状况与围手术期并发症增加无关，但与 TAVR 后 1 年死亡率增加有关。进一步的研究将评估该衰弱综合指标在老年主动脉瓣狭窄患者中的独立价值。
