title: Risk scores and biomarkers for the prediction of 1-year outcome after transcatheter aortic valve replacement.
abstract: BACKGROUND
  Up to 50% of the patients still die or have to be rehospitalized during the first year after transcatheter aortic valve replacement (TAVR). This emphasizes the need for more strategic patient selection. The aim of this prospective observational cohort study was to compare the prognostic value of risk scores and circulating biomarkers to predict all-cause mortality and rehospitalization in patients undergoing TAVR.
  
  
  METHODS
  We calculated the hazard ratios and C-statistics (area under the curve [AUC]) of 4 risk scores (logistic European System for Cardiac Operative Risk Evaluation [EuroSCORE], EuroSCORE II, Society of Thoracic Surgeons predicted risk of mortality, and German aortic valve score) and 5 biomarkers of inflammation and/or myocardial dysfunction (high-sensitivity C-reactive protein, growth differentiation factor (GDF)-15, interleukin-6, interleukin-8, and N-terminal pro-B-type natriuretic peptide) for the risk of death (n = 80) and the combination of death or rehospitalization (n = 132) during the first year after TAVR in 310 consecutive TAVR patients.
  
  
  RESULTS
  The EuroSCORE II and GDF-15 had the strongest predictive value for 1-year mortality (EuroSCORE II, AUC 0.711; GDF-15, AUC 0.686) and for the composite end point (EuroSCORE II, AUC 0.690; GDF-15, AUC 0.682). When added to the logistic EuroSCORE and EuroSCORE II, GDF-15 enhanced the prognostic performance of the score and enabled substantial reclassification of patients. Combinations of increasing tertiles of the logistic EuroSCORE or EuroSCORE II and GDF-15 allowed the stratification of the patients into subgroups with mortality rates ranging from 4.0% to 49.1% and death/rehospitalization rates ranging from 15.3% to 68.4%.
  
  
  CONCLUSIONS
  Our study identified GDF-15 in addition to the logistic EuroSCORE and the EuroSCORE II as the most promising predictors of a poor outcome after TAVR.
authors.affiliation: Heart Center, Department of Medicine II, University Hospital Bonn, Bonn, Germany. Electronic address: jan-malte.sinning@ukb.uni-bonn.de.
authors.forename: Jan-Malte
authors.initials: JM
authors.lastname: Sinning
authors.affiliation: Division of Molecular and Translational Cardiology, Hannover Medical School, Hannover, Germany; Department of Cardiology und Angiology, Hannover Medical School, Hannover, Germany.
authors.forename: Kai C
authors.initials: KC
authors.lastname: Wollert
authors.affiliation: Heart Center, Department of Medicine II, University Hospital Bonn, Bonn, Germany.
authors.forename: Alexander
authors.initials: A
authors.lastname: Sedaghat
authors.affiliation: Division of Molecular and Translational Cardiology, Hannover Medical School, Hannover, Germany; Department of Cardiology und Angiology, Hannover Medical School, Hannover, Germany.
authors.forename: Christian
authors.initials: C
authors.lastname: Widera
authors.affiliation: Heart Center, Department of Medicine II, University Hospital Bonn, Bonn, Germany.
authors.forename: Marie-Caroline
authors.initials: MC
authors.lastname: Radermacher
authors.affiliation: Heart Center, Department of Medicine II, University Hospital Bonn, Bonn, Germany.
authors.forename: Claire
authors.initials: C
authors.lastname: Descoups
authors.affiliation: Heart Center, Department of Medicine II, University Hospital Bonn, Bonn, Germany.
authors.forename: Christoph
authors.initials: C
authors.lastname: Hammerstingl
authors.affiliation: Heart Center, Department of Medicine II, University Hospital Bonn, Bonn, Germany.
authors.forename: Marcel
authors.initials: M
authors.lastname: Weber
authors.affiliation: Heart Center, Department of Medicine II, University Hospital Bonn, Bonn, Germany.
authors.forename: Anja
authors.initials: A
authors.lastname: Stundl
authors.affiliation: Heart Center, Department of Medicine II, University Hospital Bonn, Bonn, Germany.
authors.forename: Alexander
authors.initials: A
authors.lastname: Ghanem
authors.affiliation: Department of Cardiology und Angiology, Hannover Medical School, Hannover, Germany.
authors.forename: Julian
authors.initials: J
authors.lastname: Widder
authors.affiliation: Heart Center, Department of Medicine II, University Hospital Bonn, Bonn, Germany.
authors.forename: Mariuca
authors.initials: M
authors.lastname: Vasa-Nicotera
authors.affiliation: Heart Center, Department of Cardiac Surgery, University Hospital Bonn, Bonn, Germany.
authors.forename: Fritz
authors.initials: F
authors.lastname: Mellert
authors.affiliation: Heart Center, Department of Cardiac Surgery, University Hospital Bonn, Bonn, Germany.
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Schiller
authors.affiliation: Department of Cardiology und Angiology, Hannover Medical School, Hannover, Germany.
authors.forename: Johann
authors.initials: J
authors.lastname: Bauersachs
authors.affiliation: Institute for Clinical Chemistry and Clinical Pharmacology, University Hospital Bonn, Bonn, Germany.
authors.forename: Berndt
authors.initials: B
authors.lastname: Zur
authors.affiliation: Institute for Clinical Chemistry and Clinical Pharmacology, University Hospital Bonn, Bonn, Germany.
authors.forename: Stefan
authors.initials: S
authors.lastname: Holdenrieder
authors.affiliation: Heart Center, Department of Cardiac Surgery, University Hospital Bonn, Bonn, Germany.
authors.forename: Armin
authors.initials: A
authors.lastname: Welz
authors.affiliation: Heart Center, Department of Medicine II, University Hospital Bonn, Bonn, Germany.
authors.forename: Eberhard
authors.initials: E
authors.lastname: Grube
authors.affiliation: Duke Clinical Research Institute, Department of Biostatistics and Bioinformatics, Duke University, Durham, NC.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Pencina
authors.affiliation: Heart Center, Department of Medicine II, University Hospital Bonn, Bonn, Germany.
authors.forename: Georg
authors.initials: G
authors.lastname: Nickenig
authors.affiliation: Heart Center, Department of Medicine II, University Hospital Bonn, Bonn, Germany.
authors.forename: Nikos
authors.initials: N
authors.lastname: Werner
authors.affiliation: Division of Molecular and Translational Cardiology, Hannover Medical School, Hannover, Germany; Department of Cardiology und Angiology, Hannover Medical School, Hannover, Germany.
authors.forename: Tibor
authors.initials: T
authors.lastname: Kempf
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001024:Aortic Valve Stenosis / Q000401:mortality / Q000601:surgery*; D015415:Biomarkers / Q000097:blood*; D002423:Cause of Death / Q000639:trends; D005260:Female; D005500:Follow-Up Studies; D005858:Germany / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D008297:Male; D010359:Patient Readmission / Q000639:trends*; D011183:Postoperative Complications / Q000453:epidemiology*; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D015996:Survival Rate / Q000639:trends; D013997:Time Factors; D065467:Transcatheter Aortic Valve Replacement
chemical_list: D015415:Biomarkers