The Current Society of Thoracic Surgeons Model Reclassifies Mortality Risk in Patients Undergoing Transcatheter Aortic Valve Replacement

Kumar, Arnav; Sato, Kimi; Narayanswami, Jyoti; Menon, Vivek; Banerjee, Kinjal; Anumandla, Anil Kumar Reddy; Andress, Krystof; Mohananey, Divyanshu; Lokhande, Chetan; Sawant, Abhishek C.; Khan, Abdur Raheem; Krishnaswamy, Amar; Tuzcu, E. Murat; Jaber, Wael A.; Mick, Stephanie; Svensson, Lars; Kapadia, Samir

doi:10.1016/s0735-1097(18)32548-8

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“…There are currently no universally accepted morbidity and mortality prediction models to assist in the choice of the treatment modality best suited for an individual patient. Risk scores that have been employed range from institutional instruments in development specifically for TAVI to traditional and universally accepted cardiac surgical risk assessment tools, including but not confined to the Transcatheter Aortic Valve Replacement Risk Score [ 2 ], the Society of Thoracic Surgeon-Predicted Risk of Mortality (STS PROM) [ 3 ], the European System for Cardiac Operative Risk Evaluation II (EuroSCORE II) [ 4 ], the logistic EuroScore (log ES) [ 5 ], and the Society of Thoracic Surgeons (STS) [ 6 ]. Two factors that have recently found attention as possible indicators of increased mortality risks after TAVI are the presence of diabetes mellitus (DM) and the presence of possible underlying inflammatory processes.…”

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confidence: 99%

Elevated Fasting Glucose and C-Reactive Protein Levels Predict Increased All-Cause Mortality after Elective Transcatheter Aortic Valve Implantation

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et al. 2022

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Surgical aortic valve replacement in the elderly is now being supplanted by transcatheter aortic valve implantation (TAVI). Scoring systems to predict survival after catheter-based procedures are understudied. Both diabetes (DM) and underlying inflammatory conditions are common in patients undergoing TAVI, but their impact remains understudied in this patient group. We examined 560 consecutive TAVI procedures and identified eight pre-procedural factors: age, body mass index (BMI), DM, fasting blood glucose (BG), left-ventricular ejection fraction (EF), aortic valve (AV) mean gradient, C-reactive protein levels, and serum creatinine levels and studied their impact on survival. The overall mortality rate at 30 days, 1 year and 2 years were 5.2%, 16.6%, and 34.3%, respectively. All-cause mortality was higher in patients with DM (at 30 days: 8.9% vs. 3.1%, p = 0.008; at 1 year: 19.7% vs. 14.9%, p = 0.323; at 2 years: 37.9% vs. 32.2%, p = 0.304). The presence of DM was independently associated with increased 30-day mortality (hazard ratio [HR] 5.38, 95% confidence interval [CI], 1.24–23.25, p = 0.024). BG levels within 7–11, 1 mmol/L portended an increased risk for 30-day and 2-year mortality compared to normal BG (p = 0.001 and p = 0.027). For each 1 mmol/L increase in BG 30-day mortality increased (HR 1.21, 95% CI, 1.04–1.41, p = 0.015). Reduced EF and elevated CRP were each associated with increased 2-year mortality (p = 0.042 and p = 0.003). DM, elevated BG, reduced EF, and elevated baseline CRP levels each are independent predictors of short- and long-term mortality following TAVI. These easily accessible screening parameters should be integrated into risk-assessment tools for catheter-based aortic valve replacement candidates.

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