Author + information
- Suzanne Arnold,
- Ajay Kirtane,
- Susheel Kodali,
- Alan Zajarias,
- Vinod Thourani,
- Philip Green,
- Josep Rodes–Cabau,
- Maria Alu,
- Yang Lei,
- Michael Mack,
- Martin Leon and
- David Cohen
TAVR has emerged as a less invasive option for valve replacement for high–risk and inoperable patients with severe AS. However, not all TAVR patients derive a mortality or quality of life (QoL) benefit. We aimed to identify patients at high–risk for a poor outcome after TAVR.
We examined QoL and mortality outcomes among 463 patients randomized to TAVR from the PARTNER I trial. QoL was assessed using the Kansas City Cardiomyopathy Questionnaire (KCCQ, range 0–100; higher=better) at baseline and 6M. A poor 6M outcome––defined as either death, very poor QoL (KCCQ summary score <45 [~NYHA Class 4]), or a decrease in KCCQ by ≥10 points vs. baseline––occurred in 161 patients (35%). A multivariable model was constructed to identify a parsimonious set of covariates that could identify patients at high–risk for poor 6M outcome.
The final model included a combination of clinical, echocardiographic, and health status variables. The model demonstrated good discrimination (c–index=0.72) and calibration with the observed data. Based on baseline characteristics alone, the model identified 95 patients (21%) with a ≥50% likelihood of a poor 6M outcome after TAVR. The highest risk patients (top 10%) had a >66% likelihood of a poor outcome. High–risk patients (vs. low–risk) were more likely to have lower body weights (BMI: 24.6 vs. 29.6 kg/m2, p<0.001), worse kidney function (Cr: 1.4 vs. 1.2 mg/dL, p=0.073), lower mean aortic valve gradients (35 vs. 49 mmHg, p=0.004), oxygen–dependent COPD (27% vs. 5%, p<0.001), worse functional status (6–min walk distance: 37 vs. 143 m, p<0.001), worse mental health (SF–12 mental score: 36 vs. 52, p<0.001) and worse QoL at baseline (KCCQ: 28 vs. 47, p<0.001). At 6M, 33% of high–risk patients were dead and an additional 25% had very poor QoL. In comparison, only 10% of low–risk patients were dead and 7% had a very poor QoL at 6M after TAVR.
Using a large, multicenter cohort of patients undergoing TAVR, we have established a set of covariates that can identify patients at high–risk for poor 6 month outcomes after TAVR. Such a model may help guide treatment choices and provide patients realistic expectations of outcomes based on their presenting characteristics.
West, Room 2010
Sunday, March 10, 2013, 10:45 a.m.–11:00 a.m.
Session Title: Valvular Heart Disease: Prognostic Features and Technical Advances to Optimize TAVR Outcomes
Abstract Category: 32. Valvular Heart Disease: Therapy
Presentation Number: 931–3
- 2013 American College of Cardiology Foundation