Rogers Toby, Alraies M Chadi, Moussa Pacha Homam, Bond Elizabeth, Buchanan Kyle D, Steinvil Arie, Gai Jiaxiang, Torguson Rebecca, Ben-Dor Itsik, Satler Lowell F, Waksman Ron
Division of Interventional Cardiology, Heart and Vascular Institute, MedStar Washington Hospital Center, Washington, District of Columbia.
Division of Interventional Cardiology, Heart and Vascular Institute, MedStar Washington Hospital Center, Washington, District of Columbia.
Am J Cardiol. 2018 Apr 1;121(7):850-855. doi: 10.1016/j.amjcard.2017.12.035. Epub 2018 Jan 11.
Society of Thoracic Surgeons (STS) score and frailty index are calculated routinely as part of transcatheter aortic valve implantation (TAVI) assessment to determine procedure risk. We aim to evaluate the incremental improvement of STS risk score using frailty status in predicting short- and long-term outcome after TAVI. Study population included 544 consecutive TAVI patients who completed full frailty assessment and STS score calculation before the procedure. Frailty is defined by the presence of any 3 of the following 5 criteria: algorithm-defined grip strength and 15-foot walking tests, body mass index < 20 kg/m, Katz activity of daily living ≤ 4/6, serum albumin < 3.5 g/dl. Multivariable logistic analysis of 30-day and 1-year mortality was performed using a logistic regression model that comprised the STS risk score model as a single variable. Based on frailty definition, 242 patients were frail and 302 patients were not. STS score was higher in the frail group than in the nonfrail group. Compared with STS risk score alone, frailty status was a significant predictor of 1-year mortality after TAVI procedure (odds ratio 1.0, 95% confidence interval [CI] 1.0 to 1.1, p = 0.029 vs 2.75, 95% CI 1.55 to 4.87, p <0.001, respectively). Although the c-statistic of the 1-year STS risk prediction model only changed from 0.62 to 0.66 (p = 0.08), the net reclassification improvement increased significantly to 52.8% after adding frailty to the prediction model (95% CI 0.28 to 0.77, p <0.0001). Frailty status is associated with higher mortality in TAVI cohort and incrementally improves the well-validated STS risk prediction model. Frailty assessment should continue to be part of the preprocedural assessment to further improve patient outcomes after TAVI.
作为经导管主动脉瓣植入术（TAVI）评估的一部分，胸外科医师协会（STS）评分和衰弱指数会定期进行计算，以确定手术风险。我们旨在评估在预测TAVI术后短期和长期结局时，使用衰弱状态对STS风险评分的增量改善情况。研究人群包括544例连续的TAVI患者，这些患者在手术前完成了全面的衰弱评估和STS评分计算。衰弱由以下5项标准中的任意3项存在来定义：算法定义的握力和15英尺步行测试、体重指数<20kg/m²、Katz日常生活活动能力≤4/6、血清白蛋白<3.5g/dl。使用包含STS风险评分模型作为单一变量的逻辑回归模型，对30天和1年死亡率进行多变量逻辑分析。根据衰弱定义，242例患者衰弱，302例患者不衰弱。衰弱组的STS评分高于非衰弱组。与单独的STS风险评分相比，衰弱状态是TAVI手术后1年死亡率的显著预测因素（优势比分别为1.0，95%置信区间[CI]1.0至1.1，p=0.029；与2.75，95%CI1.55至4.87，p<0.001）。尽管1年STS风险预测模型的c统计量仅从0.62变为0.66（p=0.08），但在预测模型中加入衰弱后，净重新分类改善显著增加至52.8%（95%CI0.28至0.77，p<0.0001）。衰弱状态与TAVI队列中较高的死亡率相关，并逐步改善经过充分验证的STS风险预测模型。衰弱评估应继续作为术前评估的一部分，以进一步改善TAVI术后的患者结局。
