Department of Medicine, Medical College of Wisconsin (MCW), WI, USA.
Department of Internal Medicine, Advocate Illinois Masonic Medical Center, Chicago, IL, USA.
Cardiovasc Revasc Med. 2022 Jan;34:56-60. doi: 10.1016/j.carrev.2021.02.004. Epub 2021 Feb 6.
We aimed to study the impact of frailty on the outcome of transcatheter aortic valve replacement (TAVR) procedures.
The National Inpatient Sample (NIS) database was queried for all patients aged ≥65 years who underwent a TAVR procedure during the years 2016-2017. Frailty was measured using a previously validated Hospital Frailty Risk Score (HFRS) scoring system. The score is ICD-10 code based; thus, it can be calculated from an administrative database. Study outcomes were in-hospital all-cause mortality, peri-procedural complications, length of stay, and total cost. Outcomes were modeled using logistic regression for binary outcomes and generalized linear regression for continuous outcomes.
There were 84,750 patients included in the study. These patients were divided into low-risk (61,050), intermediate-risk (22,955), and high-risk (744), based on average frailty index scores of 2, 7, and 16.8, respectively. On multivariable analysis, the HFRS correlated with increased odds for mortality with an adjusted odd ratio (a-OR) of 1.25 (95% CI: 1.22-1.29, p < 0.001), myocardial infarction [a-OR 1.10 (95% CI: 1.07-1.13, p < 0.001)], pericardiocentesis [a-OR 1.16 (95% CI: 1.12-1.20, p < 0.001)], pacemaker insertion [a-OR 1.06 (95% CI: 1.04-1.08, p < 0.001)], blood transfusion [a-OR 1.14 (95% CI: 1.11-1.16, p < 0.001)], vascular complications [a-OR 1.05 (95% CI: 1.00-1.09, p = 0.03)], longer length of stay [a-MR 1.10 (95% CI: 1.10-1.11, p < 0.001)] and higher cost [a-MR: 1.04 (95% CI: 1.03-1.04, p < 0.001)].
The HFRS can be utilized in the risk stratification of older patients undergoing TAVR.
本研究旨在探讨衰弱对经导管主动脉瓣置换术（TAVR）结果的影响。
本研究使用了国家住院患者样本（NIS）数据库，纳入了 2016 年至 2017 年期间接受 TAVR 手术的所有年龄≥65 岁的患者。采用先前验证的医院衰弱风险评分（HFRS）评分系统评估衰弱情况。该评分基于国际疾病分类第 10 次修订版（ICD-10）代码，因此可以从行政数据库中计算得出。研究结果为住院期间全因死亡率、围手术期并发症、住院时间和总费用。使用逻辑回归分析二分类结局，使用广义线性回归分析连续结局。
本研究共纳入了 84750 例患者。根据平均衰弱指数评分（2、7 和 16.8），这些患者被分为低危组（61050 例）、中危组（22955 例）和高危组（744 例）。多变量分析显示，HFRS 与死亡率的增加相关，校正优势比（aOR）为 1.25（95%可信区间：1.22-1.29，p<0.001），心肌梗死（aOR 1.10 [95%可信区间：1.07-1.13，p<0.001]）、心包穿刺术（aOR 1.16 [95%可信区间：1.12-1.20，p<0.001]）、起搏器植入术（aOR 1.06 [95%可信区间：1.04-1.08，p<0.001]）、输血（aOR 1.14 [95%可信区间：1.11-1.16，p<0.001]）、血管并发症（aOR 1.05 [95%可信区间：1.00-1.09，p=0.03]）、住院时间延长（a-MR 1.10 [95%可信区间：1.10-1.11，p<0.001）和更高的成本（a-MR：1.04 [95%可信区间：1.03-1.04，p<0.001）。
HFRS 可用于 TAVR 老年患者的风险分层。
