Journal article
Evaluation of multidimensional geriatric assessment as a predictor of mortality and cardiovascular events after transcatheter aortic valve implantation.
- Stortecky S Department of Cardiology, Swiss Cardiovascular Center Bern, Bern University Hospital, Bern, Switzerland.
- Schoenenberger AW Division of Geriatrics, Department of General Internal Medicine, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland.
- Moser A Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland.
- Kalesan B Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland.
- Jüni P Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland.
- Carrel T Department of Cardiovascular Surgery, Swiss Cardiovascular Center Bern, Bern University Hospital, Bern, Switzerland.
- Bischoff S Department of Cardiology, Swiss Cardiovascular Center Bern, Bern University Hospital, Bern, Switzerland.
- Schoenenberger CM Department of Cardiology, Swiss Cardiovascular Center Bern, Bern University Hospital, Bern, Switzerland.
- Stuck AE Division of Geriatrics, Department of General Internal Medicine, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland.
- Windecker S Department of Cardiology, Swiss Cardiovascular Center Bern, Bern University Hospital, Bern, Switzerland. Electronic address: stephan.windecker@insel.ch.
- Wenaweser P Department of Cardiology, Swiss Cardiovascular Center Bern, Bern University Hospital, Bern, Switzerland.
- 2012-05-26
Published in:
- JACC. Cardiovascular interventions. - 2012
Activities of Daily Living
Age Factors
Aged
Aged, 80 and over
Aortic Valve Stenosis
Cardiac Catheterization
Cerebrovascular Disorders
Cognition
Female
Frail Elderly
Geriatric Assessment
Heart Valve Prosthesis Implantation
Humans
Linear Models
Logistic Models
Male
Mobility Limitation
Multivariate Analysis
Nutritional Status
Odds Ratio
Predictive Value of Tests
Prospective Studies
Risk Assessment
Risk Factors
Switzerland
Time Factors
Treatment Outcome
English
OBJECTIVES
This study evaluated Multidimensional Geriatric Assessment (MGA) as predictor of mortality and major adverse cardiovascular and cerebral events (MACCE) after transcatheter aortic valve implantation (TAVI).
BACKGROUND
Currently used global risk scores do not reliably estimate mortality and MACCE in these patients.
METHODS
This prospective cohort comprised 100 consecutive patients ≥ 70 years undergoing TAVI. Global risk scores (Society of Thoracic Surgeons [STS] score, EuroSCORE) and MGA-based scores (cognition, nutrition, mobility, activities of daily living [ADL], and frailty index) were evaluated as predictors of all-cause mortality and MACCE 30 days and 1 year after TAVI in regression models.
RESULTS
In univariable analyses, all predictors were significantly associated with mortality and MACCE at 30 days and 1 year, except for the EuroSCORE at 30 days and instrumental ADL at 30 days and 1 year. Associations of cognitive impairment (odds ratio [OR]: 2.98, 95% confidence interval [CI]: 1.07 to 8.31), malnutrition (OR: 6.72, 95% CI: 2.04 to 22.17), mobility impairment (OR: 6.65, 95% CI: 2.15 to 20.52), limitations in basic ADL (OR: 3.63, 95% CI: 1.29 to 10.23), and frailty index (OR: 3.68, 95% CI: 1.21 to 11.19) with 1-year mortality were similar compared with STS score (OR: 5.47, 95% CI: 1.48 to 20.22) and EuroSCORE (OR: 4.02, 95% CI: 0.86 to 18.70). Similar results were found for 30-day mortality and MACCE. Bivariable analyses, including STS score or EuroSCORE suggested independent associations of MGA-based scores (e.g., OR of frailty index: 3.29, 95% CI: 1.06 to 10.15, for 1-year mortality in a model including EuroSCORE).
CONCLUSIONS
This study provides evidence that risk prediction can be improved by adding MGA-based information to global risk scores. Larger studies are needed for the development and validation of improved risk prediction models.
This study evaluated Multidimensional Geriatric Assessment (MGA) as predictor of mortality and major adverse cardiovascular and cerebral events (MACCE) after transcatheter aortic valve implantation (TAVI).
BACKGROUND
Currently used global risk scores do not reliably estimate mortality and MACCE in these patients.
METHODS
This prospective cohort comprised 100 consecutive patients ≥ 70 years undergoing TAVI. Global risk scores (Society of Thoracic Surgeons [STS] score, EuroSCORE) and MGA-based scores (cognition, nutrition, mobility, activities of daily living [ADL], and frailty index) were evaluated as predictors of all-cause mortality and MACCE 30 days and 1 year after TAVI in regression models.
RESULTS
In univariable analyses, all predictors were significantly associated with mortality and MACCE at 30 days and 1 year, except for the EuroSCORE at 30 days and instrumental ADL at 30 days and 1 year. Associations of cognitive impairment (odds ratio [OR]: 2.98, 95% confidence interval [CI]: 1.07 to 8.31), malnutrition (OR: 6.72, 95% CI: 2.04 to 22.17), mobility impairment (OR: 6.65, 95% CI: 2.15 to 20.52), limitations in basic ADL (OR: 3.63, 95% CI: 1.29 to 10.23), and frailty index (OR: 3.68, 95% CI: 1.21 to 11.19) with 1-year mortality were similar compared with STS score (OR: 5.47, 95% CI: 1.48 to 20.22) and EuroSCORE (OR: 4.02, 95% CI: 0.86 to 18.70). Similar results were found for 30-day mortality and MACCE. Bivariable analyses, including STS score or EuroSCORE suggested independent associations of MGA-based scores (e.g., OR of frailty index: 3.29, 95% CI: 1.06 to 10.15, for 1-year mortality in a model including EuroSCORE).
CONCLUSIONS
This study provides evidence that risk prediction can be improved by adding MGA-based information to global risk scores. Larger studies are needed for the development and validation of improved risk prediction models.
- Language
-
- English
- Open access status
- bronze
- Identifiers
-
- DOI 10.1016/j.jcin.2012.02.012
- PMID 22625186
- Persistent URL
- https://sonar.ch/global/documents/1398
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