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Development of a Risk Score Based on Aortic Calcification to Predict 1-Year Mortality After Transcatheter Aortic

Pierre Lantelme1, Hélène Eltchaninoff2, Muriel Rabilloud3

  • 1Cardiology Department, Hôpital Croix-Rousse and Hôpital Lyon Sud, Hospices Civils de Lyon, Lyon, France; University of Lyon, CREATIS UMR5220, INSERM U1044, INSA-15 Lyon, France.

JACC. Cardiovascular Imaging
|May 21, 2018
PubMed

Insights

A new risk score using thoracic aortic calcification (TAC) effectively predicts cardiovascular and all-cause mortality after transcatheter aortic valve replacement (TAVR). This CAPRI score aids in identifying patients at higher risk, improving clinical decision-making.

Area of Science:

  • Cardiology
  • Radiology
  • Medical Informatics

Background:

  • Aortic calcification is linked to poorer outcomes following transcatheter aortic valve replacement (TAVR).
  • A risk score incorporating aortic calcification could identify patients with unfavorable prognoses after TAVR.

Purpose of the Study:

  • To develop and validate a novel scoring system, the CAPRI score, utilizing thoracic aortic calcification (TAC) to predict 1-year mortality.
  • To assess the predictive value of TAC in conjunction with other clinical factors for cardiovascular and all-cause mortality.

Main Methods:

  • The C4CAPRI study involved a training cohort (1,425 TAVR patients, 2010-2014) and a test cohort (311 TAVR patients, 2015).
  • Thoracic aortic calcification (TAC) was quantified via computed tomography before TAVR.
  • CAPRI risk scores were derived from Cox models incorporating TAC, comorbidities, demographics, atherosclerotic disease, and cardiac function, then validated in independent cohorts.

Main Results:

  • One-year cardiovascular and all-cause mortality rates were 13.0% and 17.9% in the training cohort, and 8.2% and 11.8% in the test cohort.
  • Each 1-cm³ increase in TAC correlated with a 6% rise in cardiovascular mortality and a 4% rise in all-cause mortality.
  • The CAPRI model demonstrated fair predictive power (AUC 68%) for both outcomes, with high correlation between predicted and observed survival, consistent across cohorts.

Conclusions:

  • The CAPRI score, integrating TAC with established prognostic factors, accurately predicts 1-year cardiovascular and all-cause mortality.
  • Validation in an independent cohort confirms the score's predictive performance and clinical relevance for decision-making in TAVR.
  • Routine use of the CAPRI score may help optimize patient selection and potentially prevent futile interventions.
Abstract

Keywords:
TAVRaortic stiffnessmortalityoutcomerisk stratification

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