Improvement in Risk Stratification in Transcatheter Aortic Valve Implantation Using a Combination of the Tumor Marker CA125 and the Logistic EuroSCORE.
OBJECTIVE
Conventional risk scores have not been accurate in predicting peri- and postprocedural risk of patients undergoing transcatheter aortic valve implantation (TAVI). Elevated levels of the tumor marker carbohydrate antigen 125 (CA125) have been linked to adverse outcomes after TAVI. We studied the additional value of CA125 to that of the EuroSCORE in predicting long-term mortality after TAVI.


RESULTS
During a median follow-up of 59 weeks, 115 of 422 patients (27%) died after TAVI. Mortality was higher with elevated CA125 (> 30 U/mL) and EuroSCORE (> median) (47% vs 20%, P<.001 and 38% vs 16%, P<.001, respectively). In the multivariable analysis, CA125 (> 30 U/mL) remained an independent predictor of mortality (hazard ratio [HR], 2.16; 95% confidence interval [95%CI], 1.48-3.15; P<.001) and improved the predictive capability of the model (C-statistic: 0.736 vs 0.731) and the net reclassification index (51% 95%CI, 33-73) with an integrated discriminative improvement of 3.5% (95%CI, 0.5-8.4). A new variable (CA125-EuroSCORE) was created, with the combinations of the 2 possible binary states of these variables (+, elevated, -, not elevated; C1: CA125- EuroSCORE-; C2: CA125+ EuroSCORE-; C3: CA125- EuroSCORE+; C4: CA125+ EuroSCORE+). Patients in C1 exhibited the lowest cumulative mortality rate (14% [26 of 181]). Mortality was intermediate for C2 (CA125 > 30 U/mL and EuroSCORE ≤ median) and C3 (CA125 ≤ 30 U/mL and EuroSCORE > median): 27% (8 of 30) and 28% (37 of 131), respectively. Patients in C4 (CA125 > 30 U/mL and EuroSCORE > median) exhibited the highest mortality (55% [44 of 80], P-value for trend<.001).


CONCLUSIONS
CA125 offers additional prognostic information beyond that obtained by the EuroSCORE. Elevation of both markers was associated with a poor prognosis.
Klinik für Herz- und Kreislauferkrankungen, Deutsches Herzzentrum München, Munich, Germany; Klinik und Poliklinik für Innere Medizin II, Universitätsklinikum Regensburg, Regensburg, Germany. Electronic address: oliver.husser@gmail.com.
Oliver
O
Husser
Departamento de Cardiología, Hospital Clínico Universitario de Valencia, Instituto de Investigación Sanitaria INCLIVA, Universidad de Valencia, Valencia, Spain.
Julio
J
Núñez
Klinik für Herz- und Kreislauferkrankungen, Deutsches Herzzentrum München, Munich, Germany.
Christof
C
Burgdorf
Klinik für Herz-, Thorax-, und herznahe Gefäßchirurgie, Universitätsklinikum Regensburg, Regensburg, Germany.
Andreas
A
Holzamer
Universitäres Herzzentrum, Kardiologie, Universitätsspital Zürich, Zurich, Switzerland.
Christian
C
Templin
Klinik für Herz- und Kreislauferkrankungen, Deutsches Herzzentrum München, Munich, Germany.
Thorsten
T
Kessler
Departamento de Cardiología, Hospital Clínico Universitario de Valencia, Instituto de Investigación Sanitaria INCLIVA, Universidad de Valencia, Valencia, Spain.
Vicente
V
Bodi
Departamento de Cardiología, Hospital Clínico Universitario de Valencia, Instituto de Investigación Sanitaria INCLIVA, Universidad de Valencia, Valencia, Spain.
Juan
J
Sanchis
Klinik für Herz- und Kreislauferkrankungen, Deutsches Herzzentrum München, Munich, Germany.
Costanza
C
Pellegrini
Klinik und Poliklinik für Innere Medizin II, Universitätsklinikum Regensburg, Regensburg, Germany.
Andreas
A
Luchner
Klinik und Poliklinik für Innere Medizin II, Universitätsklinikum Regensburg, Regensburg, Germany.
Lars S
LS
Maier
Klinik für Herz-, Thorax-, und herznahe Gefäßchirurgie, Universitätsklinikum Regensburg, Regensburg, Germany.
Christof
C
Schmid
Universitäres Herzzentrum, Kardiologie, Universitätsspital Zürich, Zurich, Switzerland.
Thomas F
TF
Lüscher
Klinik für Herz- und Kreislauferkrankungen, Deutsches Herzzentrum München, Munich, Germany; Deutsches Zentrum für Herz-Kreislauf-Forschung e.V., Partner Site Munich Heart Alliance, Munich, Germany.
Heribert
H
Schunkert
Klinik für Herz- und Kreislauferkrankungen, Deutsches Herzzentrum München, Munich, Germany; Deutsches Zentrum für Herz-Kreislauf-Forschung e.V., Partner Site Munich Heart Alliance, Munich, Germany.
Adnan
A
Kastrati
Klinik für Herz-, Thorax-, und herznahe Gefäßchirurgie, Universitätsklinikum Regensburg, Regensburg, Germany.
Michael
M
Hilker
Klinik für Herz- und Kreislauferkrankungen, Deutsches Herzzentrum München, Munich, Germany; Klinik und Poliklinik für Innere Medizin II, Universitätsklinikum Regensburg, Regensburg, Germany; Deutsches Zentrum für Herz-Kreislauf-Forschung e.V., Partner Site Munich Heart Alliance, Munich, Germany.
Christian
C
Hengstenberg
D000368:Aged; D001024:Aortic Valve Stenosis / Q000401:mortality / Q000601:surgery*; D018394:CA-125 Antigen / Q000378:metabolism*; D005260:Female; D006801:Humans; D008297:Male; D008565:Membrane Proteins / Q000378:metabolism*; D011379:Prognosis; D011446:Prospective Studies; D018570:Risk Assessment / Q000379:methods; D012720:Severity of Illness Index; D065467:Transcatheter Aortic Valve Replacement / Q000401:mortality*
D018394:CA-125 Antigen; C451759:MUC16 protein, human; D008565:Membrane Proteins
EuroSCORE logístico; Implante percutáneo de válvula aórtica; Logistic EuroSCORE; Marcador tumoral antígeno carbohidrato 125; Predicción de riesgo; Risk prediction; Transcatheter aortic valve implantation; Tumor marker carbohydrate antigen 125