Risk scores and biomarkers for the prediction of 1-year outcome after transcatheter aortic valve replacement - 17/08/15

Doi : 10.1016/j.ahj.2015.07.003

Jan-Malte Sinning, MD, PhD ^a,^{^⁎,}^{^{g
Equal contribution.}} , Kai C. Wollert, MD, PhD ^b,^c,^{^{g
Equal contribution.}}, Alexander Sedaghat, MD ^a, Christian Widera, MD ^b,^c, Marie-Caroline Radermacher ^a, Claire Descoups ^a, Christoph Hammerstingl, MD, PhD ^a, Marcel Weber, MD ^a, Anja Stundl, MD ^a, Alexander Ghanem, MD, PhD ^a, Julian Widder, MD, PhD ^c, Mariuca Vasa-Nicotera, MD, PhD ^a, Fritz Mellert, MD, PhD ^d, Wolfgang Schiller, MD ^d, Johann Bauersachs, MD, PhD ^c, Berndt Zur, MD, PhD ^e, Stefan Holdenrieder, MD, PhD ^e, Armin Welz, MD, PhD ^d, Eberhard Grube, MD, PhD ^a, Michael J. Pencina, PhD ^f, Georg Nickenig, MD, PhD ^a, Nikos Werner, MD, PhD ^a,^{^{g
Equal contribution.}}, Tibor Kempf, MD, PhD ^b,^c,^{^{g
Equal contribution.}}
^a Heart Center, Department of Medicine II, University Hospital Bonn, Bonn, Germany
^b Division of Molecular and Translational Cardiology, Hannover Medical School, Hannover, Germany
^c Department of Cardiology und Angiology, Hannover Medical School, Hannover, Germany
^d Heart Center, Department of Cardiac Surgery, University Hospital Bonn, Bonn, Germany
^e Institute for Clinical Chemistry and Clinical Pharmacology, University Hospital Bonn, Bonn, Germany
^f Duke Clinical Research Institute, Department of Biostatistics and Bioinformatics, Duke University, Durham, NC

^⁎Reprint requests: Jan-Malte Sinning, MD, Heart Center Bonn, Department of Medicine II, University Hospital Bonn, Sigmund-Freud-Straße 25, 53105 Bonn, Germany.

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Background

Up to 50% of the patients still die or have to be rehospitalized during the first year after transcatheter aortic valve replacement (TAVR). This emphasizes the need for more strategic patient selection. The aim of this prospective observational cohort study was to compare the prognostic value of risk scores and circulating biomarkers to predict all-cause mortality and rehospitalization in patients undergoing TAVR.

Methods

We calculated the hazard ratios and C-statistics (area under the curve [AUC]) of 4 risk scores (logistic European System for Cardiac Operative Risk Evaluation [EuroSCORE], EuroSCORE II, Society of Thoracic Surgeons predicted risk of mortality, and German aortic valve score) and 5 biomarkers of inflammation and/or myocardial dysfunction (high-sensitivity C-reactive protein, growth differentiation factor (GDF)–15, interleukin-6, interleukin-8, and N-terminal pro–B-type natriuretic peptide) for the risk of death (n = 80) and the combination of death or rehospitalization (n = 132) during the first year after TAVR in 310 consecutive TAVR patients.

Results

The EuroSCORE II and GDF-15 had the strongest predictive value for 1-year mortality (EuroSCORE II, AUC 0.711; GDF-15, AUC 0.686) and for the composite end point (EuroSCORE II, AUC 0.690; GDF-15, AUC 0.682). When added to the logistic EuroSCORE and EuroSCORE II, GDF-15 enhanced the prognostic performance of the score and enabled substantial reclassification of patients. Combinations of increasing tertiles of the logistic EuroSCORE or EuroSCORE II and GDF-15 allowed the stratification of the patients into subgroups with mortality rates ranging from 4.0% to 49.1% and death/rehospitalization rates ranging from 15.3% to 68.4%.