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

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• 作者：Oliver Husser ; MD^? ; ^&dagger ; ; Julio Nú ; ñ ; ez ; MD^&Dagger ; ; Eduardo Nú ; ñ ; ez ; MD^&Dagger ; ; Andreas Holzamer ; MD^§ ; ; Daniele Camboni ; MD^§ ; ; Andreas Luchner ; MD^? ; Juan Sanchis ; MD^&Dagger ; ; Vicente Bodi ; MD^&Dagger ; ; Gü ; nter A.J. Riegger ; MD^? ; Christof Schmid ; MD^§ ; ; Michael Hilker ; MD^§ ; ; ^{michael.hilker@ukr.de} ; Christian Hengstenberg ; MD^? ; ^&dagger ; ; ^{christian.hengstenberg@gmail.com}
• 关键词：biomarker ; CA125 ; joint modeling ; prognosis ; transcatheter aortic valve implantation
• 刊名：JACC: Cardiovascular Interventions
• 出版年：2013
• 出版时间：May, 2013
• 年：2013
• 卷：6
• 期：5
• 页码：487-496
• 全文大小：796 K

文摘

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Objectives

This study sought to predict the 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]).

Background

Risk stratification after TAVI remains challenging. The use of biomarkers in this setting represents an unmet need.

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 ¡Ü15.7 U/ml vs. M2 >15.7 U/ml).

Results

At a median follow-up of 183 days (interquartile range: 63 to 365) and 144 days (interquartile range: 56 to 365), 50 patients (22 % ) died and 75 patients (33 % ) experienced MACE. A 3-fold 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 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 to 4.26; p = 0.023) and MACE (HR: 1.77; 95 % CI: 1.05 to 2.98; p = 0.031). In the longitudinal analysis, lnCA125 as a time-varying exposure, was highly associated with both endpoints: HR: 1.47; 95 % CI: 1.01 to 2.14; p = 0.043 and HR: 2.26; 95 % CI: 1.28 to 3.98; p = 0.005, for death and MACE, respectively.

Conclusions

Serum levels of CA125 before and after TAVI independently predict death and MACE.