Assessing 30-Day TAVR Mortality Using a Risk Tool

Mar 23, 2018
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Authors:
Arnold SV, O’Brien SM, Vemulapalli S, et al., on behalf of the STS/ACC TVT Registry.
Citation:
Inclusion of Functional Status Measures in the Risk Adjustment of 30-Day Mortality After Transcatheter Aortic Valve Replacement: A Report From the Society of Thoracic Surgeons/American College of Cardiology TVT Registry. JACC Cardiovasc Interv 2018;11:581-589.
Summary By:
Bina Ahmed, MD, FACC

Study Questions:

Can a risk model using clinical and functional measures predict 30-day mortality after transcatheter aortic valve replacement (TAVR)?

Methods:

Data were obtained from patients in the Society of Thoracic Surgeons/American College of Cardiology Transcatheter Valve Therapy (TVT) Registry from June 2013 to May 2016. A hierarchical logistic regression model was developed and internally validated to estimate 30-day mortality after TAVR. Preprocedural clinical factors and Kansas City Cardiomyopathy Questionnaire (KCCQ) and gait speed were included as functional measures.

Results:

A total of 21,661 patients were evaluated. Overall 30-day mortality was 4.7%. Several clinical factors (older age, low body weight, worse renal function, peripheral arterial disease, prior myocardial infarction, left main coronary artery disease, tricuspid regurgitation, nonfemoral access) and functional factors (lower KCCQ scores and inability to complete 5-minute walk test) were independent predictors of 30-day mortality after TAVR. The proposed model showed modest (good) discrimination and validation for 30-day and in-hospital mortality. There was no significant variation in risk-adjusted 30-day mortality across different hospital sites.

Conclusions:

A clinical risk model that includes measures of health status and frailty can predict 30-day mortality after TAVR.

Perspective:

Current tools allow for assessing in-hospital mortality post-TAVR using mainly clinical variables. Better ways to predict long-term outcomes will be needed as TAVR expands. The risk model proposed by this study is more comprehensive and includes clinical, in addition to measures of functional status and frailty. These are known to have impact on clinical outcomes. The main application of this risk tool will be to allow a more objective and comprehensive comparison of outcomes across TAVR sites.

Keywords: Cardiomyopathies, Coronary Artery Disease, Frail Elderly, Geriatrics, Health Status, Heart Valve Prosthesis, Hospital Mortality, Mobility Limitation, Myocardial Infarction, Peripheral Arterial Disease, Risk Assessment, STS/ACC TVT Registry, Transcatheter Aortic Valve Replacement, Tricuspid Valve Insufficiency


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