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Prognostic Value of Shock Index Creatinine in Patients with Severe Aortic Stenosis Undergoing Transcatheter Aortic

Bangyuan Yang¹, Changjin Wang¹, Ting Zhou¹

¹Department of Cardiology, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China.

Cardiorenal Medicine

|September 22, 2024

Insights

The shock index creatinine (SIC) effectively predicts mid-term mortality in severe aortic stenosis patients undergoing transcatheter aortic valve replacement (TAVR). High SIC indicates increased frailty, cardiac damage, and higher mortality risk post-TAVR.

Area of Science:

Cardiology
Medical Diagnostics
Prognostic Biomarkers

Background:

Shock index (SI) and its derivatives are recognized for prognostic value in cardiovascular diseases.
Severe aortic stenosis (AS) management often involves transcatheter aortic valve replacement (TAVR).

Purpose of the Study:

To evaluate the predictive capability of shock index creatinine (SIC) for mid-term mortality in severe AS patients undergoing TAVR.
To assess the association between SIC and patient characteristics, comorbidities, and perioperative complications.

Main Methods:

Retrospective analysis of 555 severe AS patients undergoing TAVR.
Calculation of SIC: (SI × 100) - estimated creatinine clearance (CCr).
Primary endpoint: all-cause mortality; secondary endpoints: VARC-3 complications; statistical analyses: ROC curve, Cox regression, restricted cubic spline (RCS).

Main Results:

A high SIC (cutoff 16.5) was associated with significantly higher cumulative all-cause mortality (18.3% vs. 5.2%, p < 0.001).
Patients with high SIC were older, more frail, and had higher rates of moderate/severe mitral regurgitation, tricuspid regurgitation, and pulmonary hypertension.
High SIC correlated with increased acute kidney injury (10.1% vs. 3.9%, p = 0.008) and bleeding (13.6% vs. 6.7%, p = 0.014).
RCS confirmed a positive correlation between SIC and mortality; incorporating SIC improved the STS score's predictive value for 1-year mortality (AUC 0.731 vs. 0.649, p = 0.01).

Conclusions:

Elevated SIC in severe AS patients undergoing TAVR signifies increased frailty, cardiac damage, and heightened in-hospital and mid-term mortality risk.
SIC serves as a valuable tool for refining risk stratification in TAVR candidates.

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Abstract

Introduction:

Shock index (SI) and its derivatives have been reported to have prognostic value in various cardiovascular diseases. This study aims to ascertain the utility of shock index creatinine (SIC) in predicting mid-term mortality among patients with severe aortic stenosis (AS) undergoing transcatheter aortic valve replacement (TAVR).

Methods:

We conducted a retrospective analysis of 555 patients with severe AS who underwent TAVR from April 2016 to March 2023. SIC was calculated as (SI × 100) - estimated creatinine clearance (CCr). The primary endpoint was all-cause mortality during the follow-up period, and secondary endpoints included in-hospital complications as defined by the Valve Academic Research Consortium-3 (VARC-3) criteria. Patients were stratified into two groups based on the optimal cutoff value determined by the receiver-operating characteristic (ROC) curve. Cox regression analysis was employed to identify independent predictors of all-cause mortality. Additionally, restricted cubic spline (RCS) was deployed to illustrate the relationship between SIC and mortality risk. The predictive performance of risk scores was evaluated using the area under the ROC curve (AUC).

Results:

Over a mean follow-up period of 21.5 months, there were 51 cases of all-cause mortality. Patients with a high SIC, identified by a cutoff of 16.5, exhibited a significantly higher cumulative all-cause mortality compared to those with a low SIC (18.3% vs. 5.2%, p < 0.001; adjusted HR = 2.188; 95% CI 1.103-4.341, p = 0.025). Patients with a high SIC were older (p = 0.002) and exhibited a higher prevalence of frailty (p < 0.001). Furthermore, they exhibited a heightened probability of moderate or severe mitral regurgitation (p < 0.001), tricuspid regurgitation (p < 0.001), and pulmonary hypertension (p < 0.001) compared to those with a low SIC. In terms of perioperative complications, acute kidney injury (10.1% vs. 3.9%, p = 0.008) and bleeding (13.6% vs. 6.7%, p = 0.014) were more prevalent in patients with a high SIC. The RCS demonstrated a positive correlation between SIC and all-cause mortality rate. Furthermore, incorporating high SIC into the STS score improved its predictive value for 1-year all-cause mortality (AUC: 0.731 vs. 0.649, p = 0.01).

Conclusion:

Patients with a high SIC are more likely to experience frailty and cardiac damage and exhibit an increased in-hospital and mid-term mortality rate. SIC may provide additional information for risk stratification of patients undergoing TAVR.

Keywords:

Prognosis Severe aortic stenosis Shock index creatinine Transcatheter aortic valve replacement

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