Interaction Between Frailty and Access Site in Older Adults Undergoing Transcatheter Aortic Valve Replacement
| Autor: | Dae Hyun Kim, Andrew N. Rassi, Nicolo Piazza, Thierry Lefèvre, Nicolas Noiseux, Giuseppe Martucci, Sandra Lauck, Jeffrey J. Popma, Matthew Ades, Anita W. Asgar, Jonathan Afilalo, Mark D. Peterson, Laura Drudi, Marino Labinaz, John G. Webb, Louis P. Perrault, Andre Lamy |
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| Rok vydání: | 2018 |
| Předmět: |
Male
medicine.medical_specialty Canada Time Factors medicine.medical_treatment Frail Elderly 030204 cardiovascular system & hematology Logistic regression Risk Assessment Transcatheter Aortic Valve Replacement 03 medical and health sciences 0302 clinical medicine Valve replacement Risk Factors Internal medicine Post-hoc analysis Catheterization Peripheral medicine Humans 030212 general & internal medicine Prospective Studies Adverse effect Geriatric Assessment Aged Aged 80 and over Frailty business.industry Odds ratio Aortic Valve Stenosis Confidence interval United States Cardiac surgery Femoral Artery Treatment Outcome Cohort Female France Cardiology and Cardiovascular Medicine business |
| Zdroj: | JACC. Cardiovascular interventions. 11(21) |
| ISSN: | 1876-7605 |
| Popis: | The authors sought to determine whether frail older adults undergoing nonfemoral transcatheter aortic valve replacement (TAVR) procedures had a higher risk of 30-day and 12-month mortality.Frailty can help predict outcomes and guide therapy in older adults being considered for TAVR. Nonfemoral TAVR procedures are more invasive and impart a greater risk of adverse events, which may be less well tolerated in frail patients, compared with transfemoral TAVR procedures.This study was a post hoc analysis of the FRAILTY-AVR (Frailty Assessment Before Cardiac SurgeryTranscatheter Interventions) prospective multicenter cohort that consisted of older adults undergoing TAVR from 2012 to 2017. Frailty was assessed using the Essential Frailty Toolset (EFT). Endpoints of interest were 30-day and 12-month all-cause mortality. Interaction tables and multivariable logistic regression models were used to investigate statistical interaction on the additive and multiplicative scales.The cohort consisted of 723 patients with a mean age of 84 ± 6 years, of which 556 (77%) had femoral access and 167 (23%) had nonfemoral access. In frail patients with EFT scores ≥3 (35%), nonfemoral access was associated with increased 30-day mortality (odds ratio [OR]: 3.91; 95% confidence interval [CI]: 1.48 to 10.31); whereas in nonfrail patients with EFT scores 3 (65%), nonfemoral access had no effect (OR: 1.29; 95% CI: 0.34 to 4.94). There was statistical evidence of interaction between frailty and access site on 30-day mortality on the additive scale (relative excess risk due to interaction = 5.95). Nonfemoral access was associated with increased 1-year mortality in frail patients (OR: 1.98; 95% CI: 1.00 to 3.93) but not in nonfrail patients (OR: 1.83; 95% CI: 0.90 to 3.74), although there was no statistical evidence of interaction.Frail patients undergoing TAVR via a more invasive nonfemoral access face a substantially higher risk of 30-day mortality, whereas nonfrail older adults tolerate the procedure with a low short-term risk irrespective of access route. |
| Databáze: | OpenAIRE |
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