Prognostic role of CA-125 in patients undergoing transcatheter aortic valve replacement: A systematic review and...

Transcatheter aortic valve replacement (TAVR) has become a widely used therapy for patients with severe aortic stenosis. Carbohydrate antigen 125 (CA-125) is a promising biomarker in some cardiovascular diseases. This systematic review aims to assess the prognostic role of CA-125 in patients undergoing TAVR. We searched electronic databases from inception to March 2023 to include cohort studies evaluating the association between preprocedural CA-125 levels and mortality or heart failure (HF) readmission at 12 months in patients undergoing TAVR. We pooled crude (cHR) and adjusted hazard ratios (aHR) with their 95% confidence interval (CI) using a random-effects model. The risk of bias was evaluated using the QUIPS tool. The certainty of the evidence was assessed using the GRADE approach. We included five cohort studies involving 1594 patients. Higher levels of CA-125 were significantly associated with an increased risk of mortality or HF readmission using crude (cHR 2.79, 95% CI 1.45-5.36, I²  =  72%) and adjusted (aHR 3.27, 95% CI 2.07-5.18, I²  =  0%, high certainty) effect estimates compared with lower levels. Similarly, there was also associated with increased mortality using crude (cHR 2.68, 95% CI 1.99-3.60, I²  =  0%) and adjusted (aHR 2.17, 95% CI 1.54-3.07, I²  =  0%, high certainty) effect estimates. The risk of bias varied between low to moderate across studies. Our meta-analysis suggests that CA-125 has incremental prognostic value in patients undergoing TAVR. Further studies are needed to determine the clinical utility of CA-125 in guiding treatment decisions in this population.