Author + information
- M. Chadi Alraies1,
- Homam Moussa Pacha2,
- Elizabeth Bond1,
- Kyle Buchanan3,
- Toby Rogers1,
- Edward Koifman1,
- Arie Steinvil4,
- Fahed Darmoch5,
- Petros Okubagzi1,
- Rebecca Torguson3,
- Linzhi Xu1,
- Itsik Ben-Dor6,
- Augusto Pichard3,
- Lowell Satler3 and
- Ron Waksman6
- 1MedStar Washington Hospital Center, Washington, District of Columbia, United States
- 2Medstar Washingtion Hospital Center, Silver Spring, Maryland, United States
- 3Washington Hospital Center, Washington, District of Columbia, United States
- 4Medstar Washington Hospital center, Washington DC, USA, Washington, District of Columbia, United States
- 5Case Western Reserve University/St Vincent medical center, Cleveland, Ohio, United States
- 6Medstar Washington Hospital Center, Washington, District of Columbia, United States
Society of Thoracic surgery (STS) risk score is used to determine transcatheter aortic valve replacement (TAVR) procedure risk. We sought to study the incremental improvement of STS risk score using frailty status in predicting one-year outcome after TAVR.
The study population included 544 consecutive TAVR patients who had full frailty assessment and STS score calculation at time of procedure. Frailty defined by the presence of any 3 of the following 5 criteria: algorithm defined grip strength and 5-meter walking tests, BMI <20kg/m2, Katz ADL ≤4/6, serum Albumin<3.5g/dL. Multivariable logistic analysis of 30-day and 1-year mortality was performed using logistic regression model that comprised the STS risk score model as a single variable.
Based on frailty definition, 242 patients were frail, while 302 patients were not frail. STS score was higher in frail group compared to non-frail group (mean STS score 8.82 ± 6.04 vs 6.2 ± 3.56, P <0.001). Compared with STS risk score alone, frailty status was a significant predictor of 1-year mortality (odds ratio 1.0, 95% CI 1.0-1.1, p 0.029 vs. 2.75, 95% CI 1.55-4.87, p 0.001, respectively). Although the c-statistics of the 1-year STS risk prediction model changed from 0.62 to 0.66 (p = 0.08), the net reclassification improvement increased significantly after addition of frailty (52.7% CI 0.28-0.77, p < 0.0001).
Frailty status is associated with higher morality in TAVR cohort and incrementally improves the well-validated STS risk prediction model. Frailty assessment should continue to be part of the pre-operative assessment to further improve patient outcomes after TAVR.
STRUCTURAL: Valvular Disease: Aortic.