Risk Score for Prediction of Dialysis After Transcatheter Aortic Valve Replacement.
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Pasceri Vincenzo, Pelliccia Francesco, Mehran Roxana, Dangas George, Porto Italo, Radico Francesco, Biancari Fausto, D'Ascenzo Fabrizio, Saia Francesco, Luzi Giampaolo, Bedogni Francesco, Amat Santos Ignacio J, De Marzo Vincenzo, Dimagli Arnaldo, Mäkikallio Timo, Stabile Eugenio, Blasco-Turrión Sara, Testa Luca, Barbanti Marco, Tamburino Corrado, Fabiocchi Franco, Chilmeran Ahmed, Conrotto Federico, Costa Giuliano, Stefanini Giulio, Spaccarotella Carmen, Macchione Andrea, La Torre Michele, Bendandi Francesco, Juvonen Tatu, Wańha Wojciech, Wojakowski Wojtek, Benedetto Umberto, Indolfi Ciro, Hildick-Smith David, Zimarino Marco
Аннотация
METHODS AND RESULTS: A total of 10 071 consecutive patients were enrolled in 19 European centers. Patients were randomly assigned (2:1) to a derivation and validation cohort. Two scores were developed, 1 including only preprocedural variables (TRITAVIpre) and 1 also including procedural variables (TRITAVIpost). In the 6714 patients of the derivation cohort (age 82±6 years, 48% men), preprocedural factors independently associated with dialysis and included in the TRITAVIpre score were male sex, diabetes, prior coronary artery bypass graft, anemia, nonfemoral access, and creatinine clearance <30 mL/min per m2. Additional independent predictors among procedural features were volume of contrast, need for transfusion, and major vascular complications. Both scores showed a good discrimination power for identifying risk for dialysis with C-statistic 0.78 for TRITAVIpre and C-statistic 0.88 for TRITAVIpost score. Need for dialysis increased from the lowest to the highest of 3 risk score groups (from 0.3% to 3.9% for TRITAVIpre score and from 0.1% to 6.2% for TRITAVIpost score). Analysis of the 3357 patients of the validation cohort (age 82±7 years, 48% men) confirmed the good discrimination power of both scores (C-statistic 0.80 for TRITAVIpre and 0.81 for TRITAVIpost score). Need for dialysis was associated with a significant increase in 1-year mortality (from 6.9% to 54.4%; P=0.0001).
CONCLUSIONS: A simple preprocedural clinical score can help predict the risk of dialysis after transcatheter aortic valve replacement.