Rheude Tobias, Pellegrini Costanza, Schmid Hans, Trenkwalder Teresa, Mayr N Patrick, Joner Michael, Kasel Albert M, Holdenrieder Stefan, Nunez Julio, Sanchis Juan, Bodi Vicent, Schunkert Heribert, Kastrati Adnan, Hengstenberg Christian, Husser Oliver
Klinik für Herz- und Kreislauferkrankungen, Deutsches Herzzentrum München, Technische Universität München, Munich, Germany.
Institut für Anästhesiologie, Deutsches Herzzentrum München, Technische Universität München, Munich, Germany.
Am J Cardiol. 2018 Feb 15;121(4):461-468. doi: 10.1016/j.amjcard.2017.11.020. Epub 2017 Nov 27.
Elevated carbohydrate antigen 125 (CA125) and N-terminal pro-brain natriuretic peptide (NTproBNP) have been associated with adverse outcome after transcatheter aortic valve implantation (TAVI). This study performs a comparison of both biomarkers for prognosis after TAVI. The study includes 363 patients. The primary end point was all-cause death or readmission for worsening congestive heart failure within 1 year after TAVI, and this end point occurred in 16% of the population. The optimal cutoff to predict the primary end point was 18.4 U/ml for CA125 and 2,570 ng/L for NTproBNP. Elevated CA125 levels were present in 52% and were associated with a higher rate of the primary end point (27% vs 3%; p <0.001). In parallel, elevated NTproBNP levels were present in 42% and were also associated with a higher rate of the primary end point (27% vs 8%; p <0.001). After multivariable adjustment, elevated CA125 (hazard ratio [HR] 5.26; p <0.001) and elevated NTproBNP (HR 2.12; p = 0.022) were independent predictors of the primary end point. To explore the utility of combining both biomarkers, CA125 was added to the model containing baseline variables and NTproBNP. Elevated CA125 (HR 4.62; p = 0.001), but not NTproBNP (HR 1.58; p = 0.194), persisted as an independent predictor of the primary end point. Addition of CA125 significantly improved the predictive capability of the model (C-statistic: 0.805 vs 0.776) and the net reclassification index (50%, 95% confidence interval [20 to 84]) with an integrated discriminative improvement of 3.0%. In conclusion, elevated CA125 and NTproBNP predict adverse clinical outcome after TAVI. However, when combining both biomarkers, the predictive capacity of CA125 was superior.
碳水化合物抗原125（CA125）和N末端脑钠肽前体（NTproBNP）升高与经导管主动脉瓣植入术（TAVI）后的不良预后相关。本研究对这两种生物标志物在TAVI后的预后情况进行了比较。该研究纳入了363例患者。主要终点是TAVI后1年内全因死亡或因充血性心力衰竭恶化再次入院，该终点在16%的人群中出现。预测主要终点的CA125最佳临界值为18.4 U/ml，NTproBNP为2570 ng/L。52%的患者CA125水平升高，且与主要终点发生率较高相关（27%对3%；p<0.001）。同时，42%的患者NTproBNP水平升高，也与主要终点发生率较高相关（27%对8%；p<0.001）。多变量调整后，CA125升高（风险比[HR] 5.26；p<0.001）和NTproBNP升高（HR 2.12；p = 0.022）是主要终点的独立预测因素。为探讨联合使用这两种生物标志物的效用，将CA125添加到包含基线变量和NTproBNP的模型中。CA125升高（HR 4.62；p = 0.001），而NTproBNP未升高（HR 1.58；p = 0.194），仍然是主要终点的独立预测因素。添加CA125显著提高了模型的预测能力（C统计量：0.805对0.776）和净重新分类指数（50%，95%置信区间[20至84]），综合判别改善为3.0%。总之，CA125和NTproBNP升高可预测TAVI后的不良临床结局。然而，联合使用这两种生物标志物时，CA125的预测能力更优。
