Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2024 Aug 23;10(17):e36724.
doi: 10.1016/j.heliyon.2024.e36724. eCollection 2024 Sep 15.

Impact of multiple comorbidities on long-term mortality in older patients following transcatheter aortic valve replacement

Satoshi Higuchi  1 , Hidenari Matsumoto  1 , Ryota Masaki  1 , Seita Kondo  1 , Yasuhide Mochizuki  1 , Shiori Fuse  1 , Eiji Toyosaki  1 , Tomoaki Masuda  2 , Kazuto Maruta  2 , Tadashi Omoto  2 , Atsushi Aoki  2 , Toshiro Shinke  1
Affiliations

Impact of multiple comorbidities on long-term mortality in older patients following transcatheter aortic valve replacement

Satoshi Higuchi et al. Heliyon. .

Abstract

Background: Older candidates for transcatheter aortic valve replacement (TAVR) frequently present with both cardiac and noncardiac comorbidities. There are few risk scores that evaluate a wide range of comorbidities.

Methods: Patients who underwent TAVR for severe aortic stenosis were retrospectively evaluated. A new prediction model (Cardiac and nonCardiac Comorbidities risk score: 3C score) was determined based on coefficient in the multivariate Cox regression analysis for two-year all-cause mortality. C-statistics were assessed to compare the predictive abilities of the 3C score, the Charlson Comorbidities Index (CCI) score, the European System for Cardiac Operative Risk Evaluation (EuroSCORE) II, and the Model for End-stage Liver Disease eXcluding International normalized ratio (MELD-XI) score.

Results: The present study included 226 patients (age, 86 ± 5 years; males, 38 %). The values of the CCI score, EuroSCORE II, and MELD-XI score were 2 (1-3), 3.36 (2.12-4.58), and 5.35 (3.05-8.55), respectively. Multivariate Cox regression analysis identified two cardiac (left ventricular ejection fraction [LVEF] <40 % [2 points]; pulmonary hypertension [1 point]) and three noncardiac comorbidities (hepatobiliary system impairment [3 points]; estimated glomerular filtration rate <30 ml/min/1.73 m2 [1 point]; cachexia [1 point]). The C-statistics of the 3C score, EuroSCORE II, MELD-XI score, and CCI score were 0.767 (0.666-0.867), 0.610 (0.491-0.729), 0.580 (0.465-0.696), and 0.476 (0.356-0.596), respectively (p < 0.001).

Conclusions: Among cardiac and noncardiac comorbidities, special attention should be given to hepatobiliary system impairment and reduced LVEF in older patients following TAVR. The 3C score may contribute to the risk stratification.

Keywords: Comorbidity; Liver impairment; Pulmonary hypertension; Renal impairment; Transcatheter aortic valve replacement.

PubMed Disclaimer

Conflict of interest statement

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Figures

Fig. 1
Fig. 1
Comparison of the C-statistics of the 3C score and existing prediction scores The C-statistic of the 3C score (0.767 [0.666–0.867]) was significantly higher than that of the EuroSCORE (0.610 [0.491–0.729]), the MELD-XI score (0.580 [0.465–0.696]), and the CCI score (0.489 [0.367–0.611]). 3C score, Cardiac and nonCardiac Comorbidities risk score; CCI, Charlson Comorbidities Index; MELD-XI, Model for End-stage Liver Disease eXcluding International normalized ratio.
Fig. 2
Fig. 2
Association of the 3C score with 2-year all-cause mortality Fractional polynomials show that 2-year all-cause mortality increased with higher 3C scores, including LVEF <40 %, pulmonary hypertension, hepatobiliary system impairment, CKD stages 4–5, and cachexia. 3C score, Cardiac and nonCardiac Comorbidities risk score; CKD, chronic kidney disease; HR, hazard ratio; LVEF, left ventricular ejection fraction.
Supplemental Fig. 1
Supplemental Fig. 1
Distribution of the 3C score The comorbidities included in the 3C score were reduced left ventricular ejection fraction, pulmonary hypertension, hepatobiliary system impairment, chronic kidney disease stages 4–5, and cachexia. 3C score, Cardiac and nonCardiac Comorbidities risk score.
See this image and copyright information in PMC

References

    1. Eveborn G.W., Schirmer H., Heggelund G., Lunde P., Rasmussen K. The evolving epidemiology of valvular aortic stenosis. the Tromsø study. Heart. 2013;99:396–400. - PubMed
    1. Leon M.B., Smith C.R., Mack M., Miller D.C., Moses J.W., Svensson L.G., et al. Transcatheter aortic-valve implantation for aortic stenosis in patients who cannot undergo surgery. N. Engl. J. Med. 2010;363:1597–1607. - PubMed
    1. Leon M.B., Smith C.R., Mack M.J., Makkar R.R., Svensson L.G., Kodali S.K., et al. Transcatheter or surgical aortic-valve replacement in intermediate-risk patients. N. Engl. J. Med. 2016;374:1609–1620. - PubMed
    1. Mack M.J., Leon M.B., Thourani V.H., Makkar R., Kodali S.K., Russo M., et al. Transcatheter aortic-valve replacement with a balloon-expandable valve in low-risk patients. N. Engl. J. Med. 2019;380:1695–1705. - PubMed
    1. Levi A., Landes U., Assali A.R., Orvin K., Sharony R., Vaknin-Assa H., et al. Long-term outcomes of 560 consecutive patients treated with transcatheter aortic valve implantation and propensity score-matched analysis of early- versus new-generation valves. Am. J. Cardiol. 2017;119:1821–1831. - PubMed

LinkOut - more resources