Tumor Marker Carbohydrate Antigen 125 Predicts Adverse Outcome After Transcatheter Aortic Valve Implantation

Study Questions:

What is the predictive value of tumor marker carbohydrate antigen 125 (CA125) before and after transcatheter aortic valve implantation (TAVI) for all-cause death and a composite endpoint of death, admission for heart failure, myocardial infarction, and stroke (major adverse cardiac events [MACE])?

Methods:

CA125 was measured in 228 patients before and after TAVI. The association with outcomes was assessed using parametric Cox regression and joint modeling for baseline and longitudinal analyses, respectively. CA125 was evaluated as logarithm transformation and dichotomized by its median value (M1 ≤15.7 U/ml vs. M2 >15.7 U/ml). The survival estimates are presented as hazard ratios (HRs) with 95% confidence intervals (CIs).

Results:

At a median follow-up of 183 days (63-365) and 144 days (56-365), 50 patients (22%) died and 75 patients (33%) experienced MACE. A threefold increase in the rates for death and MACE was observed in patients above the median (M2 vs. M1) of CA125 (5.2 vs. 1.6 per 10 person-years and 8.3 vs. 3.3 per 10 person-years, respectively; p for both < 0.001). In a multivariable analysis adjusted for logistic EuroSCORE, New York Heart Association (NYHA) functional class III/IV, and device success, baseline values of CA125 (M2 vs. M1) independently predicted death (hazard ratio [HR], 2.18; 95% confidence interval [CI], 1.11-4.26; p = 0.023) and MACE (HR, 1.77; 95% CI, 1.05-2.98; p = 0.031). In the longitudinal analysis, InCA125 as a time-varying exposure, was highly associated with both endpoints: HR, 1.47; 95% CI, 1.01-2.14; p = 0.043 and HR, 2.26; 95% CI, 1.28-3.98; p = 0.005, for death and MACE, respectively.

Conclusions:

The authors concluded that serum levels of CA125 before and after TAVI independently predict death and MACE.

Perspective:

This study reported that CA125 was a strong predictor of death or MACE in a longitudinal setting after TAVI. Explicitly, serial CA125 measurements after TAVI were significant predictors of both outcomes, even when modeled simultaneously with time-varying N-terminal pro–B-type natriuretic peptide, logistic EuroSCORE, baseline NYHA functional class III/IV, and device success. Second, patients with elevated baseline CA125 values showed an independent increase of risk for all-cause death or MACE after TAVI. It appears that baseline CA125 values might be a useful tool for the determination of the optimal time point for TAVI, and patients with elevated levels of CA125 may require a more aggressive treatment before the procedure. However, additional prospective studies are indicated to validate these findings.

Clinical Topics: Heart Failure and Cardiomyopathies, Acute Heart Failure, Heart Failure and Cardiac Biomarkers

Keywords: Myocardial Infarction, Stroke, CA-125 Antigen, Biological Markers, Heart Failure


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