Department of Cardiology, Toyohashi Heart Center, Toyohashi, Japan.
Department of Cardiology, Nagoya Heart Center, Nagoya, Japan.
Catheter Cardiovasc Interv. 2021 Mar;97(4):E544-E551. doi: 10.1002/ccd.29130. Epub 2020 Jul 30.
Estimating 1-year life expectancy is an essential factor when evaluating appropriate indicators for transcatheter aortic valve replacement (TAVR).
It is clinically useful in developing a reliable risk model for predicting 1-year mortality after TAVR.
We evaluated 2,588 patients who underwent TAVR using data from the Optimized CathEter vAlvular iNtervention (OCEAN) Japanese multicenter registry from October 2013 to May 2017. The 1-year clinical follow-up was achieved by 99.5% of the entire population (n = 2,575). Patients were randomly divided into two cohorts: the derivation cohort (n = 1,931, 75% of the study population) and the validation cohort (n = 644). Considerable clinical variables including individual patient's comorbidities and frailty markers were used for predicting 1-year mortality following TAVR.
In the derivation cohort, a multivariate logistic regression analysis demonstrated that sex, body mass index, Clinical Frailty Scale, atrial fibrillation, peripheral artery disease, prior cardiac surgery, serum albumin, renal function as estimated glomerular filtration rate, and presence of pulmonary disease were independent predictors of 1-year mortality after TAVR. Using these variables, a risk prediction model was constructed to estimate the 1-year risk of mortality after TAVR. In the validation cohort, the risk prediction model revealed high discrimination ability and acceptable calibration with area under the curve of 0.763 (95% confidence interval, 0.728-0.795, p < .001) in the receiver operating characteristics curve analysis and a Hosmer-Lemeshow χ statistic of 5.96 (p = .65).
This risk prediction model for 1-year mortality may be a reliable tool for risk stratification and identification of adequate candidates in patients undergoing TAVR.
评估经导管主动脉瓣置换术（TAVR）的合适指标时，估计 1 年预期寿命是一个重要因素。
这在开发用于预测 TAVR 后 1 年死亡率的可靠风险模型方面具有临床意义。
我们使用 2013 年 10 月至 2017 年 5 月期间来自 Optimized CathEter vAlvular iNtervention（OCEAN）日本多中心注册中心的数据评估了 2588 例接受 TAVR 的患者。整个人群（n = 2575）中有 99.5%实现了 1 年临床随访。患者被随机分为两个队列：推导队列（n = 1931，研究人群的 75%）和验证队列（n = 644）。考虑了大量临床变量，包括患者的合并症和虚弱标志物，用于预测 TAVR 后 1 年的死亡率。
在推导队列中，多变量逻辑回归分析表明，性别、体重指数、临床虚弱量表、心房颤动、外周动脉疾病、既往心脏手术、血清白蛋白、肾功能估计肾小球滤过率和肺部疾病是 TAVR 后 1 年死亡率的独立预测因素。使用这些变量，构建了风险预测模型来估计 TAVR 后 1 年的死亡率风险。在验证队列中，该风险预测模型在接受者操作特征曲线分析中显示出较高的区分能力和可接受的校准，曲线下面积为 0.763（95%置信区间，0.728-0.795，p <.001），Hosmer-Lemeshow χ 统计量为 5.96（p =.65）。
这种 1 年死亡率风险预测模型可能是 TAVR 患者进行风险分层和识别合适患者的可靠工具。
