Journal Article

Association of comorbid burden with clinical outcomes after transcatheter aortic valve implantation

Doshi, Sagar N, Kiaii, Bob, Bagur, Rodrigo, Sponga, Sandro, Chu, Michael W A, George, Sudhakar, Sperrin, Matthew, Kwok, Chun Shing, Cotton, James M, Loretz, Lucca, Martin, Glen Philip, Mamas, Mamas A, Kinnaird, Tim, Schofield-Kelly, Lois, Ludman, Peter F, Khogali, Saib S, Anderson, Richard A, Nombela-Franco, Luis, Ratib, Karim, Biagioni, Corina, Sekar, Baskar, Toggweiler, Stefan, Torracchi, Leonardo

2018

Overview

ObjectivesTo investigate the association of the CharlsonComorbidity Index (CCI) with clinical outcomes after transcatheter aortic valve implantation (TAVI).BackgroundPatients undergoing TAVI have high comorbid burden; however, there is limited evidence of its impact on clinical outcomes.MethodsData 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.ResultsMost (60%) of patients had a CCI ≥3. A weak correlation was found between the total CCI and four different preoperative risks scores (ρ=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).ConclusionIn 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.

• Publisher: BMJ Publishing Group LTD
• Subject: Adult / Aged / Aged, 80 and over / Aortic Valve - surgery / Aortic Valve Stenosis - diagnosis / Aortic Valve Stenosis - epidemiology / Aortic Valve Stenosis - surgery / Canada - epidemiology / Cardiovascular disease / Clinical outcomes / Comorbidity / Comorbidity - trends / Consortia / Coronary vessels / Datasets / Female / Follow-Up Studies / Health sciences / Heart / Heart Valve Prosthesis / Hospitals / Humans / Italy - epidemiology / Male / Medical prognosis / Meta-analysis / Middle Aged / Mortality / Patients / Prospective Studies / Registries / Risk Assessment - methods / Risk Factors / Severity of Illness Index / Spain - epidemiology / Statistical analysis / Switzerland - epidemiology / Time Factors / Transcatheter Aortic Valve Replacement / Variables / Young Adult