Prognostic Impact of Prefrailty and Frailty in Women Undergoing TAVR: Insights From the WIN-TAVI Registry

Marija Petrovic, Alessandro Spirito, Samantha Sartori, Birgit Vogel, Didier Tchetche, Anna Sonia Petronio, Julinda Mehilli, Thierry Lefevre, Patrizia Presbitero, Piera Capranzano, Brunna Pileggi, Alessandro Iadanza, Gennaro Sardella, Nicolas M. van Mieghem, Emanuele Meliga, Yihan Feng, Nicolas Dumonteil, Rebecca Cohen, Chiara Fraccaro, Daniela TrabattoniGhada Mikhail, Maria Cruz Ferrer-Gracia, Christoph Naber, Samin K. Sharma, Yusuke Watanabe, Marie Claude Morice, George D. Dangas, Alaide Chieffo, Roxana Mehran

Research output: Contribution to journalArticlepeer-review

1 Scopus citations

Abstract

Background: The risks of prefrail and frail women undergoing transcatheter aortic valve replacement (TAVR) have not been fully examined. The aim of the analysis was to assess the prognostic impact of prefrailty and frailty in women undergoing TAVR. Methods: Women at intermediate or high surgical risk with severe aortic stenosis undergoing TAVR from the prospective multicentre WIN-TAVI (Women's International Transcatheter Aortic Valve Implantation) registry were stratified based on the number of Fried frailty criteria (weight loss, exhaustion, low physical activity, slow gait, weakness) met: nonfrail (no criteria), prefrail (1 or 2 criteria), or frail (3 or more criteria). The primary outcome at 1 year was the Valve Academic Research Consortium 2 (VARC-2) efficacy end point, a composite of mortality, stroke, myocardial infarction, hospitalisation for valve-related symptoms or heart failure, and valve-related dysfunction; secondary outcomes included the composite of VARC-2 life-threatening or major bleeding. Results: Out of 1019 women, 297 (29.1%) met at least 1 frailty criterion: 264 (25.9%) had prefrailty and 33 (3.2%) frailty. The 1-year risk of the primary outcome was significantly higher in prefrail and frail (20.2%) than in nonfrail (14.9%) women (adjusted hazard ratio [aHR] 1.51, 95% confidence interval [CI] 1.07-2.12). The risk of VARC-2 life-threatening or major bleeding was higher in prefrail or frail (19.9%) than in nonfrail (10.0%) women (aHR 2.06, 95% CI 1.42-2.97). These risks were consistently increased in the prefrail and frail groups assessed separately. Conclusions: In women undergoing TAVR, the presence of prefrailty or frailty conferred an increased risk of the VARC-2 efficacy end point and of VARC-2 life-threatening or major bleeding.

Original languageEnglish
Pages (from-to)457-467
Number of pages11
JournalCanadian Journal of Cardiology
Volume40
Issue number3
DOIs
StatePublished - Mar 2024

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