title: Using a multidimensional prognostic index (MPI) based on comprehensive geriatric assessment (CGA) to predict mortality in elderly undergoing transcatheter aortic valve implantation.
abstract: BACKGROUND
  Selection of appropriate elderly who can benefit from transcatheter 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 from January 2013 to December 2015. Consecutive patients aged ≥75 who underwent TAVI and a complete CGA were 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. Follow up was performed until December 2016 and mortality rate was assessed at one, six and 12months.
  
  
  RESULTS
  116 patients were included. Mean age was 86.2±4.2years, 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%) to MPI-2 group and three to MPI-3 group. MPI score and Euroscore were moderately correlated (Spearman correlation coefficient rs=0.27, p=0.0035). Mortality rate was significantly different between MPI groups at six and 12months (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).
  
  
  CONCLUSIONS
  This study indicates that CGA based on MPI tool is accurate to predict prognosis in elderly patients undergoing TAVI procedure.
authors.affiliation: Pôle de Gériatrie, Centre Hospitalier Universitaire de Poitiers, Université de Poitiers, Poitiers, France. Electronic address: marie-laure.bureau@chu-poitiers.fr.
authors.forename: Marie-Laure
authors.initials: ML
authors.lastname: Bureau
authors.affiliation: Pôle de Gériatrie, Centre Hospitalier Universitaire de Poitiers, Université de Poitiers, Poitiers, France.
authors.forename: Evelyne
authors.initials: E
authors.lastname: Liuu
authors.affiliation: Service de Cardiologie, Centre Hospitalier Universitaire de Poitiers, Université de Poitiers, Poitiers, France.
authors.forename: Luc
authors.initials: L
authors.lastname: Christiaens
authors.affiliation: Department of Orthogeriatrics, Rehabilitation and Stabilization, Frailty Area, E.O. Galliera Hospital, Hospital of National Relevance and High Specialization, 16128 Genoa, Italy.
authors.forename: Alberto
authors.initials: A
authors.lastname: Pilotto
authors.affiliation: Service de Cardiologie, Centre Hospitalier Universitaire de Poitiers, Université de Poitiers, Poitiers, France.
authors.forename: Jean
authors.initials: J
authors.lastname: Mergy
authors.affiliation: Pôle de Gériatrie, Centre Hospitalier Universitaire de Poitiers, Université de Poitiers, Poitiers, France.
authors.forename: Fabienne
authors.initials: F
authors.lastname: Bellarbre
authors.affiliation: Pôle Biologie, Pharmacie et Santé Publique, Centre Hospitalier Universitaire de Poitiers, Université de Poitiers, Poitiers, France; INSERM, CIC-P 1402, Centre Hospitalier Universitaire de Poitiers, Université de Poitiers, Poitiers, France.
authors.forename: Pierre
authors.initials: P
authors.lastname: Ingrand
authors.affiliation: Pôle de Gériatrie, Centre Hospitalier Universitaire de Poitiers, Université de Poitiers, Poitiers, France; INSERM, CIC-P 1402, Centre Hospitalier Universitaire de Poitiers, Université de Poitiers, Poitiers, France.
authors.forename: Marc
authors.initials: M
authors.lastname: Paccalin
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005500:Follow-Up Studies; D015577:Geriatric Assessment / Q000379:methods*; D006801:Humans; D008297:Male; D009026:Mortality / Q000639:trends; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D012720:Severity of Illness Index; D065467:Transcatheter Aortic Valve Replacement / Q000401:mortality* / Q000639:trends
keywords: Elderly; Mortality; Multidimensional prognostic index; Prognosis; Transcatheter aortic valve implantation