TY  - BOOK
AU  - Alraies, M Chadi
AU  - Ben-Dor, Itsik
AU  - Bond, Elizabeth
AU  - Buchanan, Kyle
AU  - Gai, Jiaxiang
AU  - Pacha, Homam Moussa
AU  - Rogers, Toby
AU  - Satler, Lowell F
AU  - Steinvil, Arie
AU  - Torguson, Rebecca
AU  - Waksman, Ron
TI  - Clinical Frailty as an Outcome Predictor After Transcatheter Aortic Valve Implantation
SN  - 0002-9149
PY  - 2018///
KW  - *Aortic Valve Stenosis/su [Surgery]
KW  - *Frailty/ep [Epidemiology]
KW  - *Mortality
KW  - *Transcatheter Aortic Valve Replacement
KW  - Activities of Daily Living
KW  - Aged
KW  - Aged, 80 and over
KW  - Aortic Valve Stenosis/ep [Epidemiology]
KW  - Balloon Valvuloplasty/sn [Statistics & Numerical Data]
KW  - Body Mass Index
KW  - Comorbidity
KW  - Female
KW  - Frailty/me [Metabolism]
KW  - Frailty/pp [Physiopathology]
KW  - Hand Strength
KW  - Humans
KW  - Logistic Models
KW  - Male
KW  - Multivariate Analysis
KW  - Odds Ratio
KW  - Pulmonary Disease, Chronic Obstructive/ep [Epidemiology]
KW  - Serum Albumin/me [Metabolism]
KW  - Treatment Outcome
KW  - Walk Test
KW  - MedStar Heart & Vascular Instituteon
KW  - Journal Article
N1  - Available online from MWHC library: 1995 - present, Available in print through MWHC library: 1999 - 2006
N2  - Copyright (c) 2018 Elsevier Inc. All rights reserved; Society of Thoracic Surgeons (STS) score and frailty index are calculated routinely as part of transcatheter aortic valve implantation (TAVI) assessment to determine procedure risk. We aim to evaluate the incremental improvement of STS risk score using frailty status in predicting short- and long-term outcome after TAVI. Study population included 544 consecutive TAVI patients who completed full frailty assessment and STS score calculation before the procedure. Frailty is defined by the presence of any 3 of the following 5 criteria: algorithm-defined grip strength and 15-foot walking tests, body mass index<20kg/m<sup>2</sup>, Katz activity of daily living<=4/6, serum albumin<3.5g/dl. Multivariable logistic analysis of 30-day and 1-year mortality was performed using a logistic regression model that comprised the STS risk score model as a single variable. Based on frailty definition, 242 patients were frail and 302 patients were not. STS score was higher in the frail group than in the nonfrail group. Compared with STS risk score alone, frailty status was a significant predictor of 1-year mortality after TAVI procedure (odds ratio 1.0, 95% confidence interval [CI] 1.0 to 1.1, p=0.029 vs 2.75, 95% CI 1.55 to 4.87, p<0.001, respectively). Although the c-statistic of the 1-year STS risk prediction model only changed from 0.62 to 0.66 (p=0.08), the net reclassification improvement increased significantly to 52.8% after adding frailty to the prediction model (95% CI 0.28 to 0.77, p<0.0001). Frailty status is associated with higher mortality in TAVI cohort and incrementally improves the well-validated STS risk prediction model. Frailty assessment should continue to be part of the preprocedural assessment to further improve patient outcomes after TAVI
UR  - https://dx.doi.org/10.1016/j.amjcard.2017.12.035
ER  -