Additive prognostic value of carbohydrate antigen-125 over frailty in patients undergoing transcatheter aortic valve replacement

Francisco José Romeo, Ignacio Miguel Seropian, Juan Guido Chiabrando, Juan Valle Raleigh, Maximiliano Smietniansky, Mariela Cal, Mariano Falconi, Vadim Kotowicz, Carla Romina Agatiello, Daniel Horacio Berrocal

Research output: Contribution to journalArticlepeer-review

7 Scopus citations

Abstract

Background: To evaluate the additive prognostic value of myocardial, inflammatory, and renal biomarkers according to frailty status in patients undergoing transcatheter aortic valve replacement (TAVR) for aortic stenosis (AS). Methods: A total of 111 subjects who underwent TAVR at Hospital Italiano de Buenos Aires, Argentina between January 2016 and December 2018 were retrospectively reviewed. Plasma levels of N-terminal pro-B-type natriuretic peptide (NT-proBNP), high sensitivity troponin T (hs-cTnT), C-reactive protein (CRP), cystatin-c (Cys-C) and carbohydrate antigen-125 (CA-125) were assessed prior to TAVR. Frailty status was assessed according to the fried physical frailty phenotype (FPFP). The primary endpoint was defined as all-cause death and/or readmission for worsening congestive heart failure (CHF) within the first year after TAVR. Results: Of the 111 patients included, 48/111 (43%) were considered to be “frail” according to the FPFP. Among biomarkers, we found CA-125 to be strongly associated with the primary endpoint (p =.006). CA-125 ≥ 18.2 U/ml was present in 41% and was associated with a higher rate of the primary endpoint (31% vs. 9%; p =.003). After multivariable adjustment, CA-125 ≥ 18.2 U/ml (hazard ratio [HR] 3.17; p =.024) was the only independent predictor of the primary endpoint. Finally, the inclusion of CA-125 to frailty significantly improved C-index (0.68–0.74; p <.05), and provided a Net Reclassification Improvement (NRI) of 0.34 (95% CI 0.19–0.49, p =.031), largely through reductions in risk estimates among pre-frail and frail patients. Conclusions: CA-125, a tumor biomarker, outperformed frailty for predicting the primary endpoint within the first year after TAVR.

Original languageEnglish
Pages (from-to)E263-E273
JournalCatheterization and Cardiovascular Interventions
Volume97
Issue number2
DOIs
StatePublished - 1 Feb 2021
Externally publishedYes

Keywords

  • aortic valve stenosis
  • biomarkers
  • carbohydrate antigen-125
  • frailty
  • transcatheter aortic valve replacement

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