TY - JOUR
T1 - Additive prognostic value of carbohydrate antigen-125 over frailty in patients undergoing transcatheter aortic valve replacement
AU - Romeo, Francisco José
AU - Seropian, Ignacio Miguel
AU - Chiabrando, Juan Guido
AU - Raleigh, Juan Valle
AU - Smietniansky, Maximiliano
AU - Cal, Mariela
AU - Falconi, Mariano
AU - Kotowicz, Vadim
AU - Agatiello, Carla Romina
AU - Berrocal, Daniel Horacio
N1 - Publisher Copyright:
© 2020 Wiley Periodicals LLC.
PY - 2021/2/1
Y1 - 2021/2/1
N2 - 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.
AB - 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.
KW - aortic valve stenosis
KW - biomarkers
KW - carbohydrate antigen-125
KW - frailty
KW - transcatheter aortic valve replacement
UR - http://www.scopus.com/inward/record.url?scp=85087205854&partnerID=8YFLogxK
U2 - 10.1002/ccd.29067
DO - 10.1002/ccd.29067
M3 - Article
C2 - 32597028
AN - SCOPUS:85087205854
SN - 1522-1946
VL - 97
SP - E263-E273
JO - Catheterization and Cardiovascular Interventions
JF - Catheterization and Cardiovascular Interventions
IS - 2
ER -