TY - JOUR
T1 - Association of comorbid burden with clinical outcomes after transcatheter aortic valve implantation
AU - Bagur, Rodrigo
AU - Martin, Glen Philip
AU - Nombela-Franco, Luis
AU - Doshi, Sagar N.
AU - George, Sudhakar
AU - Toggweiler, Stefan
AU - Sponga, Sandro
AU - Cotton, James M.
AU - Khogali, Saib S.
AU - Ratib, Karim
AU - Kinnaird, Tim
AU - Anderson, Richard A.
AU - Chu, Michael W.A.
AU - Kiaii, Bob
AU - Biagioni, Corina
AU - Schofield-Kelly, Lois
AU - Loretz, Lucca
AU - Torracchi, Leonardo
AU - Sekar, Baskar
AU - Kwok, Chun Shing
AU - Sperrin, Matthew
AU - Ludman, Peter F.
AU - Mamas, Mamas A.
PY - 2018/12/1
Y1 - 2018/12/1
N2 - Objectives To investigate the association of the CharlsonComorbidity Index (CCI) with clinical outcomes after transcatheter aortic valve implantation (TAVI). Background Patients undergoing TAVI have high comorbid burden; however, there is limited evidence of its impact on clinical outcomes. Methods Data from 1887 patients from the UK, Canada, Spain, Switzerland and Italy were collected between 2007 and 2016. The association of CCI with 30-day mortality, Valve Academic Research Consortium-2 (VARC-2) composite early safety, long-term survival and length of stay (LoS) was calculated using logistic regression and Cox proportional hazard models, as a whole cohort and at a country level, through a two-stage individual participant data (IPD) random effect meta-analysis. Results Most (60%) of patients had a CCI ≥3. A weak correlation was found between the total CCI and four different preoperative risks scores (p =0.16 to 0.29), and approximately 50% of patients classed as low risk from four risk prediction models still presented with a CCI ≥3. Per-unit increases in total CCI were not associated with increased odds of 30-day mortality (OR 1.09, 95% CI 0.96 to 1.24) or VARC-2 early safety (OR 1.04, 95% CI 0.96 to 1.14) but were associated with increased hazard of long-term mortality (HR 1.10, 95% CI 1.05 to 1.16). The two-stage IPD meta-analysis indicated that CCI was not associated with LoS (HR 0.97, 95% CI 0.93 to 1.02). Conclusion In this multicentre international study, patients undergoing TAVI had significant comorbid burden. We found a weak correlation between the CCI and well-established preoperative risks scores. The CCI had a moderate association with long-term mortality up to 5 years post-TAVI.
AB - Objectives To investigate the association of the CharlsonComorbidity Index (CCI) with clinical outcomes after transcatheter aortic valve implantation (TAVI). Background Patients undergoing TAVI have high comorbid burden; however, there is limited evidence of its impact on clinical outcomes. Methods Data from 1887 patients from the UK, Canada, Spain, Switzerland and Italy were collected between 2007 and 2016. The association of CCI with 30-day mortality, Valve Academic Research Consortium-2 (VARC-2) composite early safety, long-term survival and length of stay (LoS) was calculated using logistic regression and Cox proportional hazard models, as a whole cohort and at a country level, through a two-stage individual participant data (IPD) random effect meta-analysis. Results Most (60%) of patients had a CCI ≥3. A weak correlation was found between the total CCI and four different preoperative risks scores (p =0.16 to 0.29), and approximately 50% of patients classed as low risk from four risk prediction models still presented with a CCI ≥3. Per-unit increases in total CCI were not associated with increased odds of 30-day mortality (OR 1.09, 95% CI 0.96 to 1.24) or VARC-2 early safety (OR 1.04, 95% CI 0.96 to 1.14) but were associated with increased hazard of long-term mortality (HR 1.10, 95% CI 1.05 to 1.16). The two-stage IPD meta-analysis indicated that CCI was not associated with LoS (HR 0.97, 95% CI 0.93 to 1.02). Conclusion In this multicentre international study, patients undergoing TAVI had significant comorbid burden. We found a weak correlation between the CCI and well-established preoperative risks scores. The CCI had a moderate association with long-term mortality up to 5 years post-TAVI.
KW - aortic and arterial disease
KW - aortic stenosis
KW - epidemiology
KW - transcatheter valve interventions
UR - http://www.scopus.com/inward/record.url?scp=85050624051&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85050624051&partnerID=8YFLogxK
U2 - 10.1136/heartjnl-2018-313356
DO - 10.1136/heartjnl-2018-313356
M3 - Article
C2 - 30030336
AN - SCOPUS:85050624051
VL - 104
SP - 2058
EP - 2066
JO - Heart
JF - Heart
SN - 1355-6037
IS - 24
ER -