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Improved Registration of 3D CT Angiography with X-ray Fluoroscopy for Image Fusion During Transcatheter Aortic Valve Implantation
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Association of comorbid burden with clinical outcomes after transcatheter aortic valve implantation

Rodrigo Bagur1,2,3, Glen Philip Martin4, Luis Nombela-Franco5

  • 1Heart Team, London Health Sciences Centre, London, Ontario, Canada.

Heart (British Cardiac Society)
|July 22, 2018
PubMed

Insights

The Charlson Comorbidity Index (CCI) is weakly correlated with preoperative risk scores in transcatheter aortic valve implantation (TAVI) patients. However, higher CCI is moderately associated with increased long-term mortality post-TAVI.

Area of Science:

  • Cardiology
  • Geriatric Medicine
  • Health Services Research

Background:

  • Transcatheter aortic valve implantation (TAVI) patients often have significant comorbid conditions.
  • The impact of this comorbid burden on TAVI outcomes is not fully understood.
  • Existing risk scores may not fully capture the complexity of patient comorbidities.

Purpose of the Study:

  • To investigate the association between the Charlson Comorbidity Index (CCI) and clinical outcomes following TAVI.
  • To determine if CCI predicts short-term and long-term outcomes after TAVI.
  • To compare CCI with established preoperative risk scores in the TAVI population.

Main Methods:

  • A two-stage individual participant data (IPD) random effect meta-analysis was performed.
  • Data from 1887 patients across five countries (UK, Canada, Spain, Switzerland, Italy) between 2007-2016 were analyzed.
  • Logistic regression and Cox proportional hazard models assessed the association of CCI with 30-day mortality, early safety, long-term survival, and length of stay.

Main Results:

  • Most TAVI patients (60%) had a CCI of 3 or higher.
  • A weak correlation was observed between CCI and four preoperative risk scores (ρ=0.16–0.29).
  • Higher CCI was not associated with 30-day mortality or early safety but was linked to increased long-term mortality hazard (HR 1.10).

Conclusions:

  • Patients undergoing TAVI possess a substantial comorbid burden, as indicated by the CCI.
  • The CCI demonstrates a moderate association with long-term mortality up to 5 years post-TAVI.
  • CCI provides additional prognostic information beyond traditional risk scores in TAVI patients.
Abstract

Keywords:
aortic and arterial diseaseaortic stenosisepidemiologytranscatheter valve interventions

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