Risk scores and biomarkers for the prediction of 1-year outcome after transcatheter aortic valve replacement

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• 作者：Jan-Malte Sinning ; MD ; PhD^a ; ^g ; ^{jan-malte.sinning@ukb.uni-bonn.de" class="auth_mail" title="E-mail the corresponding author} ; Kai C. Wollert ; MD ; PhD^b ; ^c ; ^g ; Alexander Sedaghat ; MD^a ; Christian Widera ; MD^b ; ^c ; Marie-Caroline Radermacher^a ; Claire Descoups^a ; Christoph Hammerstingl ; MD ; PhD^a ; Marcel Weber ; MD^a ; Anja Stundl ; MD^a ; Alexander Ghanem ; MD ; PhD^a ; Julian Widder ; MD ; PhD^c ; Mariuca Vasa-Nicotera ; MD ; PhD^a ; Fritz Mellert ; MD ; PhD^d ; Wolfgang Schiller ; MD^d ; Johann Bauersachs ; MD ; PhD^c ; Berndt Zur ; MD ; PhD^e ; Stefan Holdenrieder ; MD ; PhD^e ; Armin Welz ; MD ; PhD^d ; Eberhard Grube ; MD ; PhD^a ; Michael J. Pencina ; PhD^f ; Georg Nickenig ; MD ; PhD^a ; Nikos Werner ; MD ; PhD^a ; ^g ; Tibor Kempf ; MD ; PhD^b ; ^c ; ^g
• 关键词：AUC ; area under the curve ; EuroSCORE ; European System for Cardiac Operative Risk Evaluation ; GDF-15 ; growth-differentiation factor 15 ; GAV ; German aortic valve ; IDI ; integrated discrimination improvement ; MACE ; major adverse cardiac event ; NRI ; net reclassification improvement ; NT-proBNP ; N-terminal pro&ndash ; B-type natriuretic peptide ; STS-PROM ; Society of Thoracic Surgeons predicted risk of mortality ; TAVR ; transcatheter aortic valve replacement
• 刊名：American Heart Journal
• 出版年：2015
• 出版时间：October 2015
• 年：2015
• 卷：170
• 期：4
• 页码：821-829
• 全文大小：853 K

文摘

Up to 50% of the patients still die or have to be rehospitalized during the first year after transcatheter aortic valve replacement (TAVR). This emphasizes the need for more strategic patient selection. The aim of this prospective observational cohort study was to compare the prognostic value of risk scores and circulating biomarkers to predict all-cause mortality and rehospitalization in patients undergoing TAVR.

Methods

We calculated the hazard ratios and C-statistics (area under the curve [AUC]) of 4 risk scores (logistic European System for Cardiac Operative Risk Evaluation [EuroSCORE], EuroSCORE II, Society of Thoracic Surgeons predicted risk of mortality, and German aortic valve score) and 5 biomarkers of inflammation and/or myocardial dysfunction (high-sensitivity C-reactive protein, growth differentiation factor (GDF)–15, interleukin-6, interleukin-8, and N-terminal pro–B-type natriuretic peptide) for the risk of death (n = 80) and the combination of death or rehospitalization (n = 132) during the first year after TAVR in 310 consecutive TAVR patients.

Results

The EuroSCORE II and GDF-15 had the strongest predictive value for 1-year mortality (EuroSCORE II, AUC 0.711; GDF-15, AUC 0.686) and for the composite end point (EuroSCORE II, AUC 0.690; GDF-15, AUC 0.682). When added to the logistic EuroSCORE and EuroSCORE II, GDF-15 enhanced the prognostic performance of the score and enabled substantial reclassification of patients. Combinations of increasing tertiles of the logistic EuroSCORE or EuroSCORE II and GDF-15 allowed the stratification of the patients into subgroups with mortality rates ranging from 4.0% to 49.1% and death/rehospitalization rates ranging from 15.3% to 68.4%.

Conclusions

Our study identified GDF-15 in addition to the logistic EuroSCORE and the EuroSCORE II as the most promising predictors of a poor outcome after TAVR.