Masanori Yamamoto1,2, Toshiaki Otsuka3,4, Tetsuro Shimura1, Ryo Yamaguchi1, Yuya Adachi1, Ai Kagase2, Takahiro Tokuda2, Fumiaki Yashima5,6, Yusuke Watanabe7, Norio Tada8, Toru Naganuma9, Motoharu Araki10, Futoshi Yamanaka11, Kazuki Mizutani12, Minoru Tabata13, Shun Watanabe13, Yasunori Sato14, Hiroshi Ueno15, Kensuke Takagi16, Akihiro Higashimori17, Shinichi Shirai18, Kentaro Hayashida6. 1. Department of Cardiology, Toyohashi Heart Center, Toyohashi, Japan. 2. Department of Cardiology, Nagoya Heart Center, Nagoya, Japan. 3. Department of Hygiene and Public Health, Nippon Medical School, Tokyo, Japan. 4. Center for Clinical Research, Nippon Medical School Hospital, Tokyo, Japan. 5. Department of Cardiology, Saiseikai Utsunomiya Hospital, Tochigi, Japan. 6. Department of Cardiology, Keio University School of Medicine, Tokyo, Japan. 7. Department of Cardiology, Teikyo University School of Medicine, Tokyo, Japan. 8. Department of Cardiology, Sendai Kosei Hospital, Sendai, Japan. 9. Department of Cardiology, New Tokyo Hospital, Chiba, Japan. 10. Department of Cardiology, Saiseikai Yokohama City Eastern Hospital, Yokohama, Japan. 11. Department of Cardiology, Syonan Kamakura General Hospital, Kamakura, Kanagawa, Japan. 12. Department of Cardiovascular Medicine, Osaka City University Graduate School of Medicine, Osaka, Japan. 13. Department of Cardiovascular Surgery, Tokyo Bay Urayasu-Ichikawa Medical Center, Chiba, Japan. 14. Department of Preventive Medicine and Public Health, Keio University, Minato, Japan. 15. Department of Cardiology, Toyama University Hospital, Toyama, Japan. 16. Department of Cardiology, Ogaki Municipal Hospital, Gifu, Japan. 17. Department of Cardiology, Kishiwada Tokushukai Hospital, Osaka, Japan. 18. Department of Cardiology, Kokura Memorial Hospital, Kokura, Japan.
Abstract
OBJECTIVES: Estimating 1-year life expectancy is an essential factor when evaluating appropriate indicators for transcatheter aortic valve replacement (TAVR). BACKGROUND: It is clinically useful in developing a reliable risk model for predicting 1-year mortality after TAVR. METHODS: We evaluated 2,588 patients who underwent TAVR using data from the Optimized CathEter vAlvular iNtervention (OCEAN) Japanese multicenter registry from October 2013 to May 2017. The 1-year clinical follow-up was achieved by 99.5% of the entire population (n = 2,575). Patients were randomly divided into two cohorts: the derivation cohort (n = 1,931, 75% of the study population) and the validation cohort (n = 644). Considerable clinical variables including individual patient's comorbidities and frailty markers were used for predicting 1-year mortality following TAVR. RESULTS: In the derivation cohort, a multivariate logistic regression analysis demonstrated that sex, body mass index, Clinical Frailty Scale, atrial fibrillation, peripheral artery disease, prior cardiac surgery, serum albumin, renal function as estimated glomerular filtration rate, and presence of pulmonary disease were independent predictors of 1-year mortality after TAVR. Using these variables, a risk prediction model was constructed to estimate the 1-year risk of mortality after TAVR. In the validation cohort, the risk prediction model revealed high discrimination ability and acceptable calibration with area under the curve of 0.763 (95% confidence interval, 0.728-0.795, p < .001) in the receiver operating characteristics curve analysis and a Hosmer-Lemeshow χ2 statistic of 5.96 (p = .65). CONCLUSIONS: This risk prediction model for 1-year mortality may be a reliable tool for risk stratification and identification of adequate candidates in patients undergoing TAVR.
OBJECTIVES: Estimating 1-year life expectancy is an essential factor when evaluating appropriate indicators for transcatheter aortic valve replacement (TAVR). BACKGROUND: It is clinically useful in developing a reliable risk model for predicting 1-year mortality after TAVR. METHODS: We evaluated 2,588 patients who underwent TAVR using data from the Optimized CathEter vAlvular iNtervention (OCEAN) Japanese multicenter registry from October 2013 to May 2017. The 1-year clinical follow-up was achieved by 99.5% of the entire population (n = 2,575). Patients were randomly divided into two cohorts: the derivation cohort (n = 1,931, 75% of the study population) and the validation cohort (n = 644). Considerable clinical variables including individual patient's comorbidities and frailty markers were used for predicting 1-year mortality following TAVR. RESULTS: In the derivation cohort, a multivariate logistic regression analysis demonstrated that sex, body mass index, Clinical Frailty Scale, atrial fibrillation, peripheral artery disease, prior cardiac surgery, serum albumin, renal function as estimated glomerular filtration rate, and presence of pulmonary disease were independent predictors of 1-year mortality after TAVR. Using these variables, a risk prediction model was constructed to estimate the 1-year risk of mortality after TAVR. In the validation cohort, the risk prediction model revealed high discrimination ability and acceptable calibration with area under the curve of 0.763 (95% confidence interval, 0.728-0.795, p < .001) in the receiver operating characteristics curve analysis and a Hosmer-Lemeshow χ2 statistic of 5.96 (p = .65). CONCLUSIONS: This risk prediction model for 1-year mortality may be a reliable tool for risk stratification and identification of adequate candidates in patients undergoing TAVR.
Authors: Jakub Baran; Anna Kablak-Ziembicka; Pawel Kleczynski; Ottavio Alfieri; Łukasz Niewiara; Rafał Badacz; Piotr Pieniazek; Jacek Legutko; Krzysztof Zmudka; Tadeusz Przewlocki; Jakub Podolec Journal: J Clin Med Date: 2022-04-07 Impact factor: 4.964