Multidimensional Prognostic Index and Outcomes in Older Patients Undergoing Transcatheter Aortic Valve Implantation: Survival of the Fittest
Abstract
:1. Introduction
2. Materials and Methods
2.1. Study Population
2.2. Cardiology Assessment
2.3. Comprehensive Geriatric Assessment
2.4. Outcome Measures
2.5. Statistical Analysis
3. Results
3.1. Patient Characteristics
3.2. Primary Outcomes
3.3. Secondary Outcomes
4. Discussion
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Conflicts of Interest
Appendix A
Complication | Total | MPI-1 | MPI-2–3 | Univariable OR (95% CI) | p Value |
---|---|---|---|---|---|
Post procedural stroke | 12/374 (3.2%) | 3/141 (2.1%) | 9/233 (3.9%) | 1.85 (0.49–6.95) | 0.36 |
New pacemaker | 63/376 (16.8%) | 25/141 (17.7%) | 38/233 (16.3%) | 0.90 (0.52–1.57) | 0.72 |
Vascular complication | 56/376 (14.9%) | 14/141 (9.9%) | 42/233 (18.0%) | 2.00 (1.05–3.80) | 0.04 |
Infection | 32/376 (8.5%) | 8/141 (5.7%) | 24/233 (10.3%) | 1.91 (0.83–4.37) | 0.13 |
MI postprocedural | 1/323 (85.9%) | 1/119 (0.7%) | 0/233 | - | - |
Delirium | 55/375 (14.6%) | 15/141 (10.6%) | 40/233 (17.2%) | 1.75 (0.93–3.30) | 0.08 |
Any Complication | 145/322 (45.0%) | 47/119 (39.4%) | 98/201 (48.7%) | 1.15 (0.92–2.31) | 0.11 |
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Assessment | No Problem (Value = 0) | Minor Problem (Value = 0.5) | Severe Problem (Value = 1) |
---|---|---|---|
ADL | 0 | 1–6 | 7–12 |
IADL | 0–1 | 2–7 | 8–14 |
MMSE | 28–30 | 25–27 | 0–24 |
CIRS-CI | 0 | 1–2 | ≥3 |
MUST | 0 | 1 | ≥2 |
Waterlow score | 3–9 | 10–14 | 15–45 |
Number of medications | 0–3 | 4–6 | ≥7 |
Social support network | Living with family | Institutionalized | Living alone |
Characteristic | Total (377) | MPI-1 N = 141 | MPI-2–3 N = 233 | p Value |
---|---|---|---|---|
Age (y) | 81.54 (±6.1) | 80.68 (±5.7) | 82.03 (±6.4) | 0.040 |
Men (%) | 189 (49.7%) | 96 (68.1%) | 89 (38.2%) | <0.001 |
BMI (kg/m2) | 27.2 (±4.8) | 27.35 (±4.25) | 27.14 (±5.20) | 0.697 |
Cardiovascular risk factors | ||||
Hypertension (%) | 294 (78.2%) | 101 (71.6%) | 192 (82.8%) | 0.013 |
Hypercholesterolemia (%) | 231 (61.4%) | 83 (58.9%) | 147 (63.9%) | 0.378 |
Diabetes mellitus (%) | 124 (33.1%) | 28 (19.9%) | 95 (40.9%) | <0.001 |
Current smoker (%) | 30 (8.0%) | 13 (9.2%) | 17 (7.3%) | 0.558 |
Comorbidities | ||||
Previous myocardial infarction (%) | 73 (19.4%) | 27 (19.1%) | 46 (19.7%) | 1.00 |
Previous stroke (%) | 82 (21.8%) | 21 (14.9%) | 49 (21.1%) | 0.028 |
COPD (%) | 82 (21.8%) | 35 (24.8%) | 47 (20.4%) | 0.367 |
Renal dysfunction (%) | 162 (43.5%) | 47 (33.3%) | 115 (49.4%) | 0.002 |
CIRS index | 1.91 (±0.27) | 1.84 (± 0.26) | 1.96 (±0.26) | <0.001 |
Symptoms | ||||
NYHA Class 3 or 4 (%) | 244 (64.9%) | 73 (51.8%) | 171 (73.4%) | <0.001 |
Angina CCS classification 3 or 4 (%) | 43 (11.4%) | 13 (9.4%) | 30 (13.2%) | 0.318 |
Vertigo (%) | 143 (41.4%) | 53 (40.5%) | 90 (42.5%) | 0.736 |
Echocardiography | ||||
AV area (cm2) | 0.76 (± 0.24) | 0.8 (±0.23) | 0.74 (±0.25) | 0.052 |
Peak AoV, (m/s) | 4.0 (± 0.70) | 4.0 (±0.69) | 4.0 (±0.71) | 0.923 |
Cardiovascular risk scores | ||||
Logistic Euroscore | 16.82 (±11.03) | 14.80 (±9.55) | 18.02 (±11.70) | 0.006 |
STS score | 5.47 (±3.03) | 4.29 (±2.19) | 6.17 (±3.25) | 0.228 |
CGA domains | ||||
Cognitive impairment probable (%) | 111 (29.5%) | 20 (14.2%) | 91 (39.1%) | <0.001 |
Malnutrition probable (%) | 41 (10.9%) | 5 (3.5%) | 36 (15.5%) | <0.001 |
Limitation of mobility, TUGT (%) | 48 (12.8%) | 5 (3.9%) | 43 (21.6%) | <0.001 |
Limitation of mobility, 5MGS (%) | 219 (58.2%) | 61 (48.8%) | 158 (77.5%) | <0.001 |
Reduced muscle strength, male (%) | 65 (17.3%) | 24 (17%) | 39 (16.7%) | 0.004 |
Reduces muscle strength, female (%) | 100 (26.6%) | 17 (12.1%) | 83 (35.6%) | 0.016 |
Limitation in ADL activity (%) | 111 (29.5%) | 9 (6.4%) | 102 (43.8%) | <0.001 |
Limitation in IADL activity (%) | 200 (53.2%) | 35 (24.8%) | 165 (70.8%) | <0.001 |
Variable | HR | 95% CI | p-Value |
---|---|---|---|
Age | 0.99 | 0.95–1.03 | 0.51 |
Sex (men) | 0.63 | 0.84–1.03 | 0.07 |
MPI-1 vs. MPI-2–3 | 1.99 | 1.13–3.50 | 0.02 |
Diabetes mellitus | 1.16 | 0.71–1.90 | 0.56 |
Hypercholesterolemia | 0.80 | 0.50–0.32 | 0.003 |
Peripheral artery disease | 1.34 | 0.84–2.12 | 0.23 |
Renal dysfunction | 1.85 | 1.19–2.87 | 0.006 |
Limitation of mobility (5MGST) | 2.09 | 1.15–3.65 | 0.02 |
Logistic Euroscore | 1.01 | 0.99–1.03 | 0.43 |
Post procedural stroke | 2.96 | 1.26–6.99 | 0.01 |
Delirium | 1.22 | 0.71–2.10 | 0.48 |
Variable | HR | 95% CI | p-Value |
---|---|---|---|
Age | 0.99 | 0.95–1.04 | 0.66 |
Sex (women) | 2.09 | 1.23–3.56 | 0.006 |
Diabetes mellitus | 0.88 | 0.51–1.50 | 0.63 |
Hypercholesterolemia | 0.47 | 0.28–0.80 | 0.005 |
Peripheral artery disease | 1.42 | 0.82–2.46 | 0.21 |
Renal dysfunction | 1.98 | 1.18–3.33 | 0.01 |
Limitation of mobility (5MGST) | 1.19 | 0.97–3.79 | 0.06 |
Logistic Euroscore | 1.01 | 0.98–1.03 | 0.66 |
Post procedural stroke | 3.98 | 1.59–10.05 | 0.003 |
Delirium | 0.97 | 0.52–1.81 | 0.93 |
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Goudzwaard, J.A.; Chotkan, S.; De Ronde-Tillmans, M.J.A.G.; Lenzen, M.J.; van Wiechen, M.P.H.; Ooms, J.F.W.; Polinder-Bos, H.A.; de Beer-Leentfaar, M.; Van Mieghem, N.M.; Daemen, J.; et al. Multidimensional Prognostic Index and Outcomes in Older Patients Undergoing Transcatheter Aortic Valve Implantation: Survival of the Fittest. J. Clin. Med. 2021, 10, 3529. https://doi.org/10.3390/jcm10163529
Goudzwaard JA, Chotkan S, De Ronde-Tillmans MJAG, Lenzen MJ, van Wiechen MPH, Ooms JFW, Polinder-Bos HA, de Beer-Leentfaar M, Van Mieghem NM, Daemen J, et al. Multidimensional Prognostic Index and Outcomes in Older Patients Undergoing Transcatheter Aortic Valve Implantation: Survival of the Fittest. Journal of Clinical Medicine. 2021; 10(16):3529. https://doi.org/10.3390/jcm10163529
Chicago/Turabian StyleGoudzwaard, Jeannette A., Sadhna Chotkan, Marjo J. A. G. De Ronde-Tillmans, Mattie J. Lenzen, Maarten P. H. van Wiechen, Joris F. W. Ooms, Harmke A. Polinder-Bos, Madelon de Beer-Leentfaar, Nicolas M. Van Mieghem, Joost Daemen, and et al. 2021. "Multidimensional Prognostic Index and Outcomes in Older Patients Undergoing Transcatheter Aortic Valve Implantation: Survival of the Fittest" Journal of Clinical Medicine 10, no. 16: 3529. https://doi.org/10.3390/jcm10163529
APA StyleGoudzwaard, J. A., Chotkan, S., De Ronde-Tillmans, M. J. A. G., Lenzen, M. J., van Wiechen, M. P. H., Ooms, J. F. W., Polinder-Bos, H. A., de Beer-Leentfaar, M., Van Mieghem, N. M., Daemen, J., Pilotto, A., de Jaegere, P. P. T., & Mattace-Raso, F. U. S. (2021). Multidimensional Prognostic Index and Outcomes in Older Patients Undergoing Transcatheter Aortic Valve Implantation: Survival of the Fittest. Journal of Clinical Medicine, 10(16), 3529. https://doi.org/10.3390/jcm10163529