3 years ago

Transcatheter Aortic Valve Implantation Futility Risk Model Development and Validation among Treated Patients with Aortic Stenosis Patients

Risk-benefit assessment for transcatheter aortic valve implantation (TAVI) is still evolving. A sizeable group of patients do not fully benefit from intervention despite technically successful procedure. All patients who underwent TAVI with device success and with no VARC-2 defined complications were included. Various demographic data, clinical details and echocardiographic findings were examined. The outcome was defined as 1-year composite of mortality, stroke, lack of functional-class improvement (by NYHA class), and readmissions (≥1 month post procedure). Logistic regression was used to fit the prediction model. We used 10-fold cross-validation to validate our results. Out of 543 patients, 435 met inclusion criteria. Mean age was 82 (±6.5) years, 43% were males, and mean STS score was 6.6 (±4.7). At 1-year, 66/435 (15%) patients experienced the study endpoint. Final logistic regression model included diabetes, baseline NYHA functional class, diastolic dysfunction, need for diuretics, AV mean gradient, hemoglobin level, and creatinine level. The area under the curve (AUC) was 0.73 and was reduced to 0.71 after validation, with 97% specificity using a single cutoff. Dividing to low, medium and high-risk groups for futility produced corresponding prevalence of 6, 19, and 59% futility. A web-application for the prediction model was developed and is provided. In conclusion, this prediction score may provide important insight and facilitate identifying patients who, despite technically successful and uncomplicated procedure, have risk that may outweigh the benefit of a contemplated TAVI.

Publisher URL: www.sciencedirect.com/science

DOI: S000291491731473X

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