P1794Futility risk model development and validation among patients with aortic stenosis treated with transcatheter aortic valve replacement
| العنوان: | P1794Futility risk model development and validation among patients with aortic stenosis treated with transcatheter aortic valve replacement |
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| المؤلفون: | C Saint Etienne, Arnaud Bisson, Denis Angoulvant, L Quilliet, A Bernard, Julien Herbert, Thierry Bourguignon, J M Clerc, Pierre Lantelme, L Guillon Grammatico, Fabrice Ivanes, D Babuty, Thibaud Lacour, L Fauchier |
| المصدر: | European Heart Journal. 40 |
| بيانات النشر: | Oxford University Press (OUP), 2019. |
| سنة النشر: | 2019 |
| مصطلحات موضوعية: | Risk model, medicine.medical_specialty, Stenosis, Transcatheter aortic, Valve replacement, business.industry, Internal medicine, medicine.medical_treatment, Cardiology, Medicine, Cardiology and Cardiovascular Medicine, business, medicine.disease |
| الوصف: | Risk-benefit assessment for transcatheter aortic valve replacement (TAVR) is still a matter of debate. A sizeable group of patients do not fully benefit from intervention despite a technically successful procedure. We therefore sought to identify patients with a bad outcome early after the procedure, and to develop a prediction model and calculator for identification of these patients. Methods Based on the French administrative hospital-discharge database, the study collected information for all consecutive patients with aortic stenosis treated with transfemoral TAVR in France between 2008 and 2018. Multivariate logistic regression was used to select the risk factors of early all-cause death in first year after TAVR procedure (considered as futility) for the overall population. Score points were assigned to each risk factor using the β coefficient. Internal validation was performed by a bootstrap method. Calibration was assessed with the Hosmer-Lemeshow goodness of fit test and accuracy with the C-statistic. Results A total of 47,872 patients with transfemoral TAVR were included in the analysis (mean age 83±7 years). Mean follow-up was 1.31±1.61 years and 9,338 deaths were recorded (yearly rate 14.9%), among which 4,562 (49%) occurred in first year after TAVR procedure. The final logistic regression model included older age, male sex, history of hospital stay with heart failure, history of acute pulmonary oedema, atrial fibrillation, previous stroke, vascular disease, diabetes, renal disease, liver disease, pulmonary disease, anemia, history of cancer, metastasis and denutrition,. The area under the curve (AUC) for the score was 0.696 (95% CI 0.688–0.704). This score outperformed frailty index and Charlson comorbidity index for identifying futility. AUC was 0.677 (95% CI 0.669–0.86) for internal validation. The Hosmer–Lemeshow goodness of fit test had a p-value of 0.10 suggesting that the model was accurate. We further divided the model into 4 groups with 5%, 12%, 19% and 30% futility, respectively. The low-risk group consisted of 60% of the patients and the high-risk group consisted of 4% of these patients. Conclusion This futility prediction score established from a large nationwide cohort of patients treated with TAVR may provide a relevant insight for optimizing healthcare decision. It may facilitate identification of patients who, despite an apparently successful procedure, have risk of death that may outweigh the benefit of an anticipated TAVR. |
| تدمد: | 1522-9645 0195-668X |
| URL الوصول: | https://explore.openaire.eu/search/publication?articleId=doi_________::41aeceb863bb569d8c97a6d9de63e1c1 https://doi.org/10.1093/eurheartj/ehz748.0546 |
| حقوق: | OPEN |
| رقم الأكسشن: | edsair.doi...........41aeceb863bb569d8c97a6d9de63e1c1 |
| قاعدة البيانات: | OpenAIRE |
| تدمد: | 15229645 0195668X |
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