title: Tumor marker carbohydrate antigen 125 predicts adverse outcome after transcatheter aortic valve implantation.
abstract: OBJECTIVE
  This study sought to predict the value of tumor marker carbohydrate antigen 125 (CA125) before and after transcatheter aortic valve implantation (TAVI) for all-cause death and a composite endpoint of death, admission for heart failure, myocardial infarction, and stroke (major adverse cardiac events [MACE]).
  
  
  BACKGROUND
  Risk stratification after TAVI remains challenging. The use of biomarkers in this setting represents an unmet need.
  
  
  METHODS
  CA125 was measured in 228 patients before and after TAVI. The association with outcomes was assessed using parametric Cox regression and joint modeling for baseline and longitudinal analyses, respectively. CA125 was evaluated as logarithm transformation and dichotomized by its median value (M1 ≤15.7 U/ml vs. M2 >15.7 U/ml).
  
  
  RESULTS
  At a median follow-up of 183 days (interquartile range: 63 to 365) and 144 days (interquartile range: 56 to 365), 50 patients (22%) died and 75 patients (33%) experienced MACE. A 3-fold increase in the rates for death and MACE was observed in patients above the median (M2 vs. M1) of CA125 (5.2 vs. 1.6 per 10 person-years and 8.3 vs. 3.3 per 10 person-years, respectively; p for both <0.001). In a multivariable analysis adjusted for logistic EuroSCORE, New York Heart Association functional class III/IV, and device success, baseline values of CA125 (M2 vs. M1) independently predicted death (hazard ratio [HR]: 2.18; 95% confidence interval [CI]: 1.11 to 4.26; p = 0.023) and MACE (HR: 1.77; 95% CI: 1.05 to 2.98; p = 0.031). In the longitudinal analysis, lnCA125 as a time-varying exposure, was highly associated with both endpoints: HR: 1.47; 95% CI: 1.01 to 2.14; p = 0.043 and HR: 2.26; 95% CI: 1.28 to 3.98; p = 0.005, for death and MACE, respectively.
  
  
  CONCLUSIONS
  Serum levels of CA125 before and after TAVI independently predict death and MACE.
authors.affiliation: Klinik und Poliklinik für Innere Medizin II, University of Regensburg Medical Center, Regensburg, Germany.
authors.forename: Oliver
authors.initials: O
authors.lastname: Husser
authors.forename: Julio
authors.initials: J
authors.lastname: Núñez
authors.forename: Eduardo
authors.initials: E
authors.lastname: Núñez
authors.forename: Andreas
authors.initials: A
authors.lastname: Holzamer
authors.forename: Daniele
authors.initials: D
authors.lastname: Camboni
authors.forename: Andreas
authors.initials: A
authors.lastname: Luchner
authors.forename: Juan
authors.initials: J
authors.lastname: Sanchis
authors.forename: Vicente
authors.initials: V
authors.lastname: Bodi
authors.forename: Günter A J
authors.initials: GA
authors.lastname: Riegger
authors.forename: Christof
authors.initials: C
authors.lastname: Schmid
authors.forename: Michael
authors.initials: M
authors.lastname: Hilker
authors.forename: Christian
authors.initials: C
authors.lastname: Hengstenberg
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001022:Aortic Valve Insufficiency / Q000097:blood / Q000401:mortality / Q000628:therapy*; D001024:Aortic Valve Stenosis / Q000097:blood / Q000401:mortality / Q000628:therapy*; D015415:Biomarkers / Q000097:blood; D018394:CA-125 Antigen / Q000097:blood*; D006328:Cardiac Catheterization / Q000009:adverse effects* / Q000401:mortality; D002318:Cardiovascular Diseases / Q000097:blood / Q000209:etiology* / Q000401:mortality / Q000628:therapy; D005260:Female; D006333:Heart Failure / Q000097:blood / Q000209:etiology; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects* / Q000401:mortality; D006760:Hospitalization; D006801:Humans; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D008137:Longitudinal Studies; D008297:Male; D008565:Membrane Proteins / Q000097:blood*; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000097:blood / Q000209:etiology; D016016:Proportional Hazards Models; D012042:Registries; D018570:Risk Assessment; D012307:Risk Factors; D020521:Stroke / Q000097:blood / Q000209:etiology; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D015415:Biomarkers; D018394:CA-125 Antigen; C451759:MUC16 protein, human; D008565:Membrane Proteins