Camarzana Audrey, Annweiler Cédric, Pinaud Frédéric, Abi-Khalil Wissam, Rouleau Frédéric, Duval Guillaume, Prunier Fabrice, Furber Alain, Biere Loïc
Institut Mitovasc, University of Angers, Angers, France.
Department of Geriatric Medicine, University Memory Center, Research Center on Autonomy and Longevity, University Hospital, Angers, France; UPRES EA 4638, University of Angers, Angers, France.
Arch Med Sci. 2021 Mar 24;18(6):1446-1452. doi: 10.5114/aoms/109391. eCollection 2022.
Despite suffering a severe aortic stenosis, some patients are denied either surgical or transcatheter aortic valve implantation (TAVI) therapy because of a frail condition. We aimed to identify whether a comprehensive geriatric assessment (CGA) might be useful to predict the prognosis of presumably frail patients with severe aortic stenosis.
Between March 2011 and July 2016, 818 patients were consecutively and prospectively enrolled. 161 had a CGA and were considered for analysis. Considering combined CGA and heart team recommendations, 102 TAVI procedures were performed (TAVI group) and 59 patients constituted the no-TAVI group. The primary endpoint was all-cause mortality at 1 year.
There was no difference between the TAVI and the no-TAVI groups considering morphometric data, cardiovascular risk factors or symptoms. The no-TAVI group had higher surgical risk (logistic EuroSCORE1 33.4 ±17.8 vs. 22.7 ±14.9; < 0.001) and more moderate renal insufficiency (82% vs. 57%; = 0.001). One-year mortality was 16% in the TAVI group and 46% in the no-TAVI group ( < 0.001). Multivariate analysis revealed that history of pulmonary edema, moderate renal failure, and not having a TAVI were associated with 1-year mortality. There was an interaction between the Five-Times-Sit-to-Stand-Test (FTSST) and the effect of TAVI on mortality ( = 0.049), as FTSST was the only predictor for 1-year mortality in the no-TAVI group (HR = 0.18, 95% CI: 0.04-0.76; = 0.019).
One-year mortality was higher in geriatric-assessed frail patients who did not undergo TAVI. FTSST, which assesses patients' mobility, was the only prognostic marker for 1-year mortality, on top of the usual medical parameters.
尽管患有严重的主动脉瓣狭窄，但一些患者因身体虚弱而被拒绝接受手术或经导管主动脉瓣植入术（TAVI）治疗。我们旨在确定全面老年评估（CGA）是否有助于预测可能身体虚弱的严重主动脉瓣狭窄患者的预后。
2011年3月至2016年7月，连续前瞻性纳入818例患者。161例接受了CGA并纳入分析。综合考虑CGA和心脏团队的建议，进行了102例TAVI手术（TAVI组），59例患者构成非TAVI组。主要终点是1年时的全因死亡率。
在形态学数据、心血管危险因素或症状方面，TAVI组和非TAVI组之间没有差异。非TAVI组的手术风险更高（逻辑欧洲心脏手术风险评估系统1 33.4±17.8 vs. 22.7±14.9；P<0.001），中度肾功能不全更多（82% vs. 57%；P = 0.001）。TAVI组1年死亡率为16%，非TAVI组为46%（P<0.001）。多变量分析显示，肺水肿病史、中度肾衰竭和未接受TAVI与1年死亡率相关。五次坐立试验（FTSST）与TAVI对死亡率的影响之间存在交互作用（P = 0.049），因为FTSST是非TAVI组中1年死亡率的唯一预测因素（风险比=0.18，95%置信区间：0.04 - 0.76；P = 0.019）。
未接受TAVI的经老年评估的身体虚弱患者1年死亡率更高。评估患者活动能力的FTSST是除常规医学参数外1年死亡率的唯一预后标志物。
