Department of Cardiology, Kokura Memorial Hospital, Kitakyushu, Japan.
Department of Cardiology, Kokura Memorial Hospital, Kitakyushu, Japan.
Am Heart J. 2024 Sep;275:141-150. doi: 10.1016/j.ahj.2024.05.017. Epub 2024 Jun 12.
The semiquantitative Clinical Frailty Scale (CFS) is reportedly a useful marker for predicting short- and mid-term mortality after transcatheter aortic valve implantation (TAVI). We assessed the long-term prognostic impact of CFS in patients with severe aortic stenosis undergoing TAVI.
We prospectively assessed patients undergoing TAVI in Kokura Memorial Hospital using a 9-level CFS and enrolled 1594 patients after excluding patients with CFS 8-9. The patients were divided into the low (CFS level, 1-3; N = 842), intermediate (4; N = 469), and high (5-7; N = 283) groups according to their CFS levels.
In the low, intermediate, and high groups, 3-year all-cause mortality rates were 17.4%, 29.4%, and 41.7% (P < .001) and composite rates of cardiovascular mortality and heart failure hospitalization were 12.1%, 19.1%, and 23.9% (P < .001), respectively. Multivariable analysis showed that higher frailty was independently associated with all-cause mortality (intermediate group: adjusted hazard ratio [HR], 1.63, 95% confidence interval [CI], 1.24-2.15, P < .001; high group: adjusted HR, 2.18, 95% CI, 1.59-2.99, P < .001) and composite of cardiovascular mortality and heart failure hospitalization (intermediate group: adjusted HR, 1.47, 95% CI, 1.04-2.08, P = .030; high group: adjusted HR, 1.66, 95% CI, 1.09-2.51, P = .018) and this result was consistent, irrespective of stratification based on age, sex, body mass index, left ventricular ejection fraction, Society of Thoracic Surgeons score, and New York Heart Association functional class without significant interaction.
The simple CFS tool predicts the long-term adverse outcomes post-TAVI.
据报道，半定量临床虚弱量表（CFS）是预测经导管主动脉瓣植入术（TAVI）后短期和中期死亡率的有用标志物。我们评估了 CFS 在接受 TAVI 的严重主动脉瓣狭窄患者中的长期预后影响。
我们前瞻性评估了在小仓纪念医院接受 TAVI 的患者，使用 9 级 CFS，并排除了 CFS 8-9 级的患者后，共纳入 1594 例患者。根据 CFS 水平，患者分为低（CFS 水平 1-3；N=842）、中（4；N=469）和高（5-7；N=283）组。
在低、中、高组，3 年全因死亡率分别为 17.4%、29.4%和 41.7%（P<.001），心血管死亡率和心力衰竭住院的复合率分别为 12.1%、19.1%和 23.9%（P<.001）。多变量分析显示，较高的虚弱程度与全因死亡率独立相关（中组：调整后的危险比[HR]，1.63，95%置信区间[CI]，1.24-2.15，P<.001；高组：调整后的 HR，2.18，95%CI，1.59-2.99，P<.001）和心血管死亡率和心力衰竭住院的复合终点（中组：调整后的 HR，1.47，95%CI，1.04-2.08，P=0.030；高组：调整后的 HR，1.66，95%CI，1.09-2.51，P=0.018），且该结果一致，无论基于年龄、性别、体重指数、左心室射血分数、胸外科医生评分和纽约心脏协会功能分级的分层，均无显著交互作用。
简单的 CFS 工具可预测 TAVI 后的长期不良结局。
