Relation of Frailty to Outcomes After Transcatheter Aortic Valve Replacement (from the PARTNER Trial)

被引:199
作者
Green, Philip [1 ,2 ]
Arnold, Suzanne V. [3 ]
Cohen, David J. [3 ]
Kirtane, Ajay J. [1 ,2 ]
Kodali, Susheel K. [1 ,2 ]
Brown, David L. [4 ]
Rihal, Charanjit S. [5 ]
Xu, Ke [1 ,2 ]
Lei, Yang [3 ]
Hawkey, Marian C. [1 ,2 ]
Kim, Rebeca J. [6 ]
Alu, Maria C. [1 ,2 ]
Leon, Martin B. [1 ,2 ]
Mack, Michael J. [6 ,7 ]
机构
[1] Columbia Univ, Med Ctr, New York Presbyterian Hosp, Herbert & Sandi Feinberg Intervent Cardiol & Hear, New York, NY 10027 USA
[2] Cardiovasc Res Fdn, New York, NY USA
[3] St Lukes Mid Amer Heart Inst, Kansas City, MO USA
[4] Baylor Healthcare Syst, Plano, TX USA
[5] Mayo Clin, Rochester, MN USA
[6] CRSTI, Plano, TX USA
[7] Baylor Scott & White Hlth, Plano, TX USA
关键词
ELDERLY-PATIENTS; OLDER-ADULTS; GAIT SPEED; IMPLANTATION; PREDICTOR; PLACEMENT; MORTALITY; SURVIVAL; STENOSIS; IMPACT;
D O I
10.1016/j.amjcard.2015.03.061
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Transcatheter aortic valve replacement (TAVR) is an effective treatment for severe symptomatic aortic stenosis (AS) in patients who are inoperable or at high risk for surgery. However, the intermediate- to long-term mortality is high, emphasizing the importance of patient selection. We, therefore, sought to evaluate the prognostic value of frailty in older recipients of TAVR, hypothesizing that frail patients would experience a higher mortality rate and a higher likelihood of poor outcome 1 year after TAVR. This substudy of the Placement of Aortic Transcatheter Valves trial was conducted at 3 high-enrolling sites where frailty was assessed systematically before TAVR. In total, 244 patients received TAVR at the participating sites. Frailty was assessed using a composite of 4 markers (serum albumin, dominant handgrip strength, gait speed, and Katz activity of daily living survey), which were combined into a frailty score. The cohort was dichotomized at median frailty score. Outcomes measures were the time to death from any cause for >1 year of follow-up and poor outcome at 1 year. Poor outcome was defined as (1) death, (2) Kansas City Cardiomyopathy Questionnaire overall summary (KCCQ-OS) score <60, or (3) decrease of >= 10 points in the KCCQ-OS score from baseline to 1 year. At 1 year, the Kaplan-Meier estimated all-cause mortality rate was 32.7% in the frail group and 15.9% in the nonfrail group (log-rank p = 0.004). At 1 year, poor outcome occurred in 50.0% of the frail group and 31.5% of the nonfrail group (p = 0.02). In conclusion, frailty was associated with increased mortality and a higher rate of poor outcome 1 year after TAVR. (C) 2015 Elsevier Inc. All rights reserved.
引用
收藏
页码:264 / 269
页数:6
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