4.6 Article

Using a multidimensional prognostic index (MPI) based on comprehensive geriatric assessment (CGA) to predictmortality in elderly undergoing transcatheter aortic valve implantation

Journal

INTERNATIONAL JOURNAL OF CARDIOLOGY
Volume 236, Issue -, Pages 381-386

Publisher

ELSEVIER IRELAND LTD
DOI: 10.1016/j.ijcard.2017.02.048

Keywords

Transcatheter aortic valve implantation; Elderly; Prognosis; Mortality; Multidimensional prognostic index

Funding

  1. MPI_AGE European project - Executive Agency for Health and Consumers (EAHC)

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Background: Selection of appropriate elderlywho can benefit fromtranscatheter aortic valve implantation (TAVI) is challenging. We evaluated the prognosis of this procedure according to the comprehensive geriatric assessment (CGA) based on the multidimensional prognostic index (MPI). Methods: Prospective observational monocentric study fromJanuary 2013 to December 2015. Consecutive patients aged = 75 who underwent TAVI and a complete CGAwere included. Baseline demographic, geriatric and cardiologic data were collected. CGA was used to calculate the MPI score that is divided in three groups according to the mortality risk. Followupwas performed until December 2016 and mortality ratewas assessed at one, six and 12months. Results: 116 patients were included. Mean age was 86.2 +/- 4.2 years, mean European system for cardiac operative risk evaluation (EuroSCORE) was 19.2 +/- 11.3%, mean MPI score was 0.39 +/- 0.13. Forty-five (38.8%) patients belonged to MPI-1 group, 68 (58.6%) toMPI-2 group and three toMPI-3 group. MPI score and Euroscorewere moderately correlated (Spearman correlation coefficient rs= 0.27, p= 0.0035). Mortality ratewas significantly different betweenMPI groups at six and 12 months (p= 0.040 and p= 0.022). Kaplan Meier survival estimates at one year stratified by MPI groups was significantly different (hazard ratio HR= 2.83, 95% confidence interval (CI) 1.38-5.82, p= 0.004). Among variables retained to perform logistic regression analysis, the score of instrumental activities of daily living appeared the most relevant (p < 0.001). Conclusion: This study indicates that CGA based on MPI tool is accurate to predict prognosis in elderly patients undergoing TAVI procedure. (C) 2017 Elsevier B.V. All rights reserved.

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