Husser Oliver, Núñez Julio, Burgdorf Christof, Holzamer Andreas, Templin Christian, Kessler Thorsten, Bodi Vicente, Sanchis Juan, Pellegrini Costanza, Luchner Andreas, Maier Lars S, Schmid Christof, Lüscher Thomas F, Schunkert Heribert, Kastrati Adnan, Hilker Michael, Hengstenberg Christian
Klinik für Herz- und Kreislauferkrankungen, Deutsches Herzzentrum München, Munich, Germany; Klinik und Poliklinik für Innere Medizin II, Universitätsklinikum Regensburg, Regensburg, Germany.
Departamento de Cardiología, Hospital Clínico Universitario de Valencia, Instituto de Investigación Sanitaria INCLIVA, Universidad de Valencia, Valencia, Spain.
Rev Esp Cardiol (Engl Ed). 2017 Mar;70(3):186-193. doi: 10.1016/j.rec.2016.08.004. Epub 2016 Sep 9.
Conventional risk scores have not been accurate in predicting peri- and postprocedural risk of patients undergoing transcatheter aortic valve implantation (TAVI). Elevated levels of the tumor marker carbohydrate antigen 125 (CA125) have been linked to adverse outcomes after TAVI. We studied the additional value of CA125 to that of the EuroSCORE in predicting long-term mortality after TAVI.
During a median follow-up of 59 weeks, 115 of 422 patients (27%) died after TAVI. Mortality was higher with elevated CA125 (> 30 U/mL) and EuroSCORE (> median) (47% vs 20%, P<.001 and 38% vs 16%, P<.001, respectively). In the multivariable analysis, CA125 (> 30 U/mL) remained an independent predictor of mortality (hazard ratio [HR], 2.16; 95% confidence interval [95%CI], 1.48-3.15; P<.001) and improved the predictive capability of the model (C-statistic: 0.736 vs 0.731) and the net reclassification index (51% 95%CI, 33-73) with an integrated discriminative improvement of 3.5% (95%CI, 0.5-8.4). A new variable (CA125-EuroSCORE) was created, with the combinations of the 2 possible binary states of these variables (+, elevated, -, not elevated; C1: CA125- EuroSCORE-; C2: CA125+ EuroSCORE-; C3: CA125- EuroSCORE+; C4: CA125+ EuroSCORE+). Patients in C1 exhibited the lowest cumulative mortality rate (14% [26 of 181]). Mortality was intermediate for C2 (CA125 > 30 U/mL and EuroSCORE ≤ median) and C3 (CA125 ≤ 30 U/mL and EuroSCORE > median): 27% (8 of 30) and 28% (37 of 131), respectively. Patients in C4 (CA125 > 30 U/mL and EuroSCORE > median) exhibited the highest mortality (55% [44 of 80], P-value for trend<.001).
CA125 offers additional prognostic information beyond that obtained by the EuroSCORE. Elevation of both markers was associated with a poor prognosis.
传统风险评分在预测经导管主动脉瓣植入术（TAVI）患者围手术期及术后风险方面并不准确。肿瘤标志物糖类抗原125（CA125）水平升高与TAVI术后不良结局相关。我们研究了CA125相对于欧洲心脏手术风险评估系统（EuroSCORE）在预测TAVI术后长期死亡率方面的附加价值。
在中位随访59周期间，422例患者中有115例（27%）在TAVI术后死亡。CA125升高（>30 U/mL）和EuroSCORE升高（>中位数）的患者死亡率更高（分别为47%对20%，P<0.001；38%对16%，P<0.001）。在多变量分析中，CA125（>30 U/mL）仍然是死亡率的独立预测因子（风险比[HR]，2.16；95%置信区间[95%CI]，1.48 - 3.15；P<0.001），并提高了模型的预测能力（C统计量：0.736对0.731）和净重新分类指数（51% 95%CI，33 - 73），综合判别改善为3.5%（95%CI，0.5 - 8.4）。创建了一个新变量（CA125 - EuroSCORE），由这两个变量的两种可能二元状态组合而成（+，升高； - ，未升高；C1：CA125 - EuroSCORE - ；C2：CA125 + EuroSCORE - ；C3：CA125 - EuroSCORE + ；C4：CA125 + EuroSCORE + ）。C1组患者的累积死亡率最低（14%[181例中的26例]）。C2组（CA125>30 U/mL且EuroSCORE≤中位数）和C3组（CA125≤30 U/mL且EuroSCORE>中位数）的死亡率处于中间水平：分别为27%（30例中的8例）和28%（131例中的37例）。C4组（CA125>30 U/mL且EuroSCORE>中位数）患者的死亡率最高（55%[80例中的44例]，趋势P值<0.001）。
CA125提供了超越EuroSCORE所获得的额外预后信息。两种标志物升高均与预后不良相关。
