Development of a Risk Score Based on Aortic Calcification to Predict 1-Year Mortality After Transcatheter Aortic Valve Replacement
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Author + information
- Pierre Lantelme, MD, PhDa,b,∗ (pierre.lantelme{at}chu-lyon.fr),
- Hélène Eltchaninoff, MD, PhDc,
- Muriel Rabilloud, MD, PhDd,e,f,g,
- Géraud Souteyrand, MD, PhDh,
- Marion Dupré, MDc,
- Marco Spaziano, MDi,j,
- Marc Bonnet, MDa,
- Clément Becle, MDa,b,
- Benjamin Riche, PhDd,e,f,g,
- Eric Durand, MD, PhDc,
- Erik Bouvier, MDi,
- Jean-Nicolas Dacher, MD, PhDk,
- Pierre-Yves Courand, MD, PhDa,b,
- Lucie Cassagnes, MD, PhDl,
- Eduardo E. Dávila Serrano, PhDb,
- Pascal Motreff, MD, PhDh,
- Loic Boussel, MD, PhDb,m,
- Thierry Lefèvre, MDi and
- Brahim Harbaoui, MD, PhDa,b
- aCardiology Department, Hôpital Croix-Rousse and Hôpital Lyon Sud, Hospices Civils de Lyon, Lyon, France
- bUniversity of Lyon, CREATIS UMR5220, INSERM U1044, INSA-15 Lyon, France
- cCardiology Service, Rouen–Charles-Nicolle University Hospital Center, National Institute of Health and Medical Research U644, Rouen, France
- dHospices Civils de Lyon, Service de Biostatistique et Bioinformatique, F-69003 Lyon, France
- eUniversité de Lyon, F-69000 Lyon, France
- fUniversité Lyon 1, F-69100 Villeurbanne, France
- gCNRS, UMR 5558, Laboratoire de Biométrie et Biologie Evolutive, Equipe Biostatistique-Santé, F-69100 Villeurbanne, France
- hDepartment of Cardiology, Gabriel Montpied University Hospital Center, Image Science for Interventional Techniques, Cardiovascular Interventional Therapy and Imaging, National Scientific Research Center UMR 6284, University of Auvergne, Clermont-Ferrand, France
- iInstitut Cardiovasculaire Paris Sud, Ramsay–Générale de Santé, France
- jDepartment of Cardiology, McGill University Health Center, Montreal, Canada
- kRadiology Department, Rouen–Charles-Nicolle University Hospital Center Rouen, France
- lRadiology Department, Gabriel Montpied University Hospital Center, and Institut Pascal, TGI UMR6602 CNRS UCA SIGMA, Faculté de Médecine, Clermont-Ferrand, France
- mRadiology Department, Hôpital Croix-Rousse, Hospices Civils de Lyon, Lyon, France
- ↵∗Address for correspondence:
Prof. Pierre Lantelme, Cardiology Department, Hôpital Croix-Rousse and Hôpital Lyon Sud, 103 Grande Rue de la Croix-Rousse, F-69004, Lyon, France.
Graphical abstract
Abstract
Objectives The aim of this study was to develop a new scoring system based on thoracic aortic calcification (TAC) to predict 1-year cardiovascular and all-cause mortality.
Background A calcified aorta is often associated with poor prognosis after transcatheter aortic valve replacement (TAVR). A risk score encompassing aortic calcification may be valuable in identifying poor TAVR responders.
Methods The C4CAPRI (4 Cities for Assessing CAlcification PRognostic Impact) multicenter study included a training cohort (1,425 patients treated using TAVR between 2010 and 2014) and a contemporary test cohort (311 patients treated in 2015). TAC was measured by computed tomography pre-TAVR. CAPRI risk scores were based on the linear predictors of Cox models including TAC in addition to comorbidities and demographic, atherosclerotic disease and cardiac function factors. CAPRI scores were constructed and tested in 2 independent cohorts.
Results Cardiovascular and all-cause mortality at 1 year was 13.0% and 17.9%, respectively, in the training cohort and 8.2% and 11.8% in the test cohort. The inclusion of TAC in the model improved prediction: 1-cm3 increase in TAC was associated with a 6% increase in cardiovascular mortality and a 4% increase in all-cause mortality. The predicted and observed survival probabilities were highly correlated (slopes >0.9 for both cardiovascular and all-cause mortality). The model’s predictive power was fair (AUC 68% [95% confidence interval [CI]: 64% to 72%]) for both cardiovascular and all-cause mortality. The model performed similarly in the training and test cohorts.
Conclusions The CAPRI score, which combines the TAC variable with classical prognostic factors, is predictive of 1-year cardiovascular and all-cause mortality. Its predictive performance was confirmed in an independent contemporary cohort. CAPRI scores are highly relevant to current practice and strengthen the evidence base for decision making in valvular interventions. Its routine use may help prevent futile procedures.
Footnotes
All authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received November 26, 2017.
- Revision received March 6, 2018.
- Accepted March 20, 2018.
- 2019 American College of Cardiology Foundation
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