Transcatheter aortic valve implantation-related futility: prevalence, predictors, and clinical risk model
Futility denotes failure to achieve the projected outcome. We investigated the prevalence, predictors, and clinical risk model of transcatheter aortic valve implantation (TAVI)-related futility. We included 464 consecutive patients undergoing TAVI from 2010 to 2017. Futility was defined as death and...
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| Veröffentlicht in: | Heart and vessels 2020-09, Vol.35 (9), p.1281-1289 |
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| creator | Higuchi, Ryosuke Saji, Mike Hagiya, Kenichi Takamisawa, Itaru Shimizu, Jun Tobaru, Tetsuya Iguchi, Nobuo Takanashi, Shuichiro Takayama, Morimasa Isobe, Mitsuaki |
| description | Futility denotes failure to achieve the projected outcome. We investigated the prevalence, predictors, and clinical risk model of transcatheter aortic valve implantation (TAVI)-related futility. We included 464 consecutive patients undergoing TAVI from 2010 to 2017. Futility was defined as death and/or hospitalization for heart failure (HFH) within 1 year after TAVI. Of 464 patients (mean age: 84.4 years), 69% were females (EuroSCOREII: 6.3%; Society of Thoracic Surgeons [STS] score: 6.9%). Forty-six patients (9.9%) experienced TAVI-related futility, and 36 of 46 patients (69.6%) died within 1 year due to cardiac (37.5%) and non-cardiac (62.5%) causes. Previous HFH (hazard ratio [HR], 2.20; 95% confidence interval [CI]: 1.13–4.35,
p
= 0.020), chronic obstructive pulmonary disease (COPD) (HR, 3.39; 95% CI: 1.12–8.42,
p
= 0.033), and moderate/severe mitral or tricuspid regurgitation (HR, 2.98; 95% CI: 1.32–6.27,
p
= 0.010) were independent predictors of futility. With 1 point assigned to each predictor (total 0 point, futility low-risk; total 1 point, futility intermediate-risk; total 2–3 points, futility high-risk), the futility risk model clearly stratified individual futility risk into three groups (the freedom from futility at 1 year: 96.2%, 82.1%, and 67.9% each). Our futility risk model presented better discrimination than EuroSCOREII, and STS score (c-statistic: 0.73 vs. 0.68 vs. 0.67). Medical futility was recognized in 9.9% of patients undergoing TAVI. Previous HFH, COPD, and concomitant atrioventricular regurgitation were associated with futility. The risk model derived from three predictors showed good performance in predicting futility risk. |
| doi_str_mv | 10.1007/s00380-020-01599-9 |
| format | Article |
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p
= 0.020), chronic obstructive pulmonary disease (COPD) (HR, 3.39; 95% CI: 1.12–8.42,
p
= 0.033), and moderate/severe mitral or tricuspid regurgitation (HR, 2.98; 95% CI: 1.32–6.27,
p
= 0.010) were independent predictors of futility. With 1 point assigned to each predictor (total 0 point, futility low-risk; total 1 point, futility intermediate-risk; total 2–3 points, futility high-risk), the futility risk model clearly stratified individual futility risk into three groups (the freedom from futility at 1 year: 96.2%, 82.1%, and 67.9% each). Our futility risk model presented better discrimination than EuroSCOREII, and STS score (c-statistic: 0.73 vs. 0.68 vs. 0.67). Medical futility was recognized in 9.9% of patients undergoing TAVI. Previous HFH, COPD, and concomitant atrioventricular regurgitation were associated with futility. The risk model derived from three predictors showed good performance in predicting futility risk.</description><identifier>ISSN: 0910-8327</identifier><identifier>ISSN: 1615-2573</identifier><identifier>EISSN: 1615-2573</identifier><identifier>DOI: 10.1007/s00380-020-01599-9</identifier><identifier>PMID: 32253528</identifier><language>eng</language><publisher>Tokyo: Springer Japan</publisher><subject>Aged ; Aged, 80 and over ; Aorta ; Aortic valve ; Aortic Valve - diagnostic imaging ; Aortic Valve - physiopathology ; Aortic Valve - surgery ; Aortic Valve Stenosis - diagnostic imaging ; Aortic Valve Stenosis - mortality ; Aortic Valve Stenosis - physiopathology ; Aortic Valve Stenosis - surgery ; Biomedical Engineering and Bioengineering ; Cardiac Surgery ; Cardiology ; Chronic obstructive pulmonary disease ; Clinical Decision Rules ; Confidence intervals ; Congestive heart failure ; Databases, Factual ; Female ; Heart Failure - diagnosis ; Heart Failure - epidemiology ; Heart Failure - mortality ; Heart Failure - physiopathology ; Heart valves ; Humans ; Implantation ; Japan - epidemiology ; Lung diseases ; Male ; Medical Futility ; Medicine ; Medicine & Public Health ; Obstructive lung disease ; Original Article ; Patient Readmission ; Patients ; Performance prediction ; Predictive Value of Tests ; Prevalence ; Regurgitation ; Retrospective Studies ; Rheumatic heart disease ; Risk ; Risk Assessment ; Risk Factors ; Statistical analysis ; Thorax ; Time Factors ; Transcatheter Aortic Valve Replacement - adverse effects ; Transcatheter Aortic Valve Replacement - mortality ; Treatment Outcome ; Vascular Surgery</subject><ispartof>Heart and vessels, 2020-09, Vol.35 (9), p.1281-1289</ispartof><rights>Springer Japan KK, part of Springer Nature 2020</rights><rights>Springer Japan KK, part of Springer Nature 2020.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c399t-1fc59a10f4e9b5b6813eb8abb7eda58d182e1de5c345d4172003a8f5dadf7bcb3</citedby><cites>FETCH-LOGICAL-c399t-1fc59a10f4e9b5b6813eb8abb7eda58d182e1de5c345d4172003a8f5dadf7bcb3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s00380-020-01599-9$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s00380-020-01599-9$$EHTML$$P50$$Gspringer$$H</linktohtml><link.rule.ids>314,776,780,27901,27902,41464,42533,51294</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/32253528$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Higuchi, Ryosuke</creatorcontrib><creatorcontrib>Saji, Mike</creatorcontrib><creatorcontrib>Hagiya, Kenichi</creatorcontrib><creatorcontrib>Takamisawa, Itaru</creatorcontrib><creatorcontrib>Shimizu, Jun</creatorcontrib><creatorcontrib>Tobaru, Tetsuya</creatorcontrib><creatorcontrib>Iguchi, Nobuo</creatorcontrib><creatorcontrib>Takanashi, Shuichiro</creatorcontrib><creatorcontrib>Takayama, Morimasa</creatorcontrib><creatorcontrib>Isobe, Mitsuaki</creatorcontrib><title>Transcatheter aortic valve implantation-related futility: prevalence, predictors, and clinical risk model</title><title>Heart and vessels</title><addtitle>Heart Vessels</addtitle><addtitle>Heart Vessels</addtitle><description>Futility denotes failure to achieve the projected outcome. We investigated the prevalence, predictors, and clinical risk model of transcatheter aortic valve implantation (TAVI)-related futility. We included 464 consecutive patients undergoing TAVI from 2010 to 2017. Futility was defined as death and/or hospitalization for heart failure (HFH) within 1 year after TAVI. Of 464 patients (mean age: 84.4 years), 69% were females (EuroSCOREII: 6.3%; Society of Thoracic Surgeons [STS] score: 6.9%). Forty-six patients (9.9%) experienced TAVI-related futility, and 36 of 46 patients (69.6%) died within 1 year due to cardiac (37.5%) and non-cardiac (62.5%) causes. Previous HFH (hazard ratio [HR], 2.20; 95% confidence interval [CI]: 1.13–4.35,
p
= 0.020), chronic obstructive pulmonary disease (COPD) (HR, 3.39; 95% CI: 1.12–8.42,
p
= 0.033), and moderate/severe mitral or tricuspid regurgitation (HR, 2.98; 95% CI: 1.32–6.27,
p
= 0.010) were independent predictors of futility. With 1 point assigned to each predictor (total 0 point, futility low-risk; total 1 point, futility intermediate-risk; total 2–3 points, futility high-risk), the futility risk model clearly stratified individual futility risk into three groups (the freedom from futility at 1 year: 96.2%, 82.1%, and 67.9% each). Our futility risk model presented better discrimination than EuroSCOREII, and STS score (c-statistic: 0.73 vs. 0.68 vs. 0.67). Medical futility was recognized in 9.9% of patients undergoing TAVI. Previous HFH, COPD, and concomitant atrioventricular regurgitation were associated with futility. The risk model derived from three predictors showed good performance in predicting futility risk.</description><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Aorta</subject><subject>Aortic valve</subject><subject>Aortic Valve - diagnostic imaging</subject><subject>Aortic Valve - physiopathology</subject><subject>Aortic Valve - surgery</subject><subject>Aortic Valve Stenosis - diagnostic imaging</subject><subject>Aortic Valve Stenosis - mortality</subject><subject>Aortic Valve Stenosis - physiopathology</subject><subject>Aortic Valve Stenosis - surgery</subject><subject>Biomedical Engineering and Bioengineering</subject><subject>Cardiac Surgery</subject><subject>Cardiology</subject><subject>Chronic obstructive pulmonary disease</subject><subject>Clinical Decision Rules</subject><subject>Confidence intervals</subject><subject>Congestive heart failure</subject><subject>Databases, Factual</subject><subject>Female</subject><subject>Heart Failure - diagnosis</subject><subject>Heart Failure - epidemiology</subject><subject>Heart Failure - mortality</subject><subject>Heart Failure - physiopathology</subject><subject>Heart valves</subject><subject>Humans</subject><subject>Implantation</subject><subject>Japan - epidemiology</subject><subject>Lung diseases</subject><subject>Male</subject><subject>Medical Futility</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Obstructive lung disease</subject><subject>Original Article</subject><subject>Patient Readmission</subject><subject>Patients</subject><subject>Performance prediction</subject><subject>Predictive Value of Tests</subject><subject>Prevalence</subject><subject>Regurgitation</subject><subject>Retrospective Studies</subject><subject>Rheumatic heart disease</subject><subject>Risk</subject><subject>Risk Assessment</subject><subject>Risk Factors</subject><subject>Statistical analysis</subject><subject>Thorax</subject><subject>Time Factors</subject><subject>Transcatheter Aortic Valve Replacement - adverse effects</subject><subject>Transcatheter Aortic Valve Replacement - mortality</subject><subject>Treatment Outcome</subject><subject>Vascular Surgery</subject><issn>0910-8327</issn><issn>1615-2573</issn><issn>1615-2573</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2020</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kUtPxSAQhYnR6PXxB1wYEjcurPIoFtwZ4ysxcaNrQmGqKG2vQE3893K9PhIXLsiQ8M0Z5hyEdik5ooQ0x4kQLklFWDlUKFWpFTSjJ1RUTDR8Fc2IoqSSnDUbaDOlZ7KgqFpHG5wxwQWTM-TvoxmSNfkJMkRsxpi9xW8mvAH2_TyYIZvsx6GKEEwGh7sp--Dz-ymeRygcDBYOF3fnbR5jOsRmcNgGP3hrAo4-veB-dBC20VpnQoKdr7qFHi4v7s-vq9u7q5vzs9vKcqVyRTsrlKGkq0G1oj2RlEMrTds24IyQjkoG1IGwvBaupg0rJhjZCWdc17S25VvoYKk7j-PrBCnr3icLoawC45Q047Ip_jAqC7r_B30epziU32lWM0UaVssFxZaUjWNKETo9j7438V1TohdB6GUQugShP4PQqjTtfUlPbQ_up-Xb-QLwJZDK0_AI8Xf2P7IfASuVag</recordid><startdate>20200901</startdate><enddate>20200901</enddate><creator>Higuchi, Ryosuke</creator><creator>Saji, Mike</creator><creator>Hagiya, Kenichi</creator><creator>Takamisawa, Itaru</creator><creator>Shimizu, Jun</creator><creator>Tobaru, Tetsuya</creator><creator>Iguchi, Nobuo</creator><creator>Takanashi, Shuichiro</creator><creator>Takayama, Morimasa</creator><creator>Isobe, Mitsuaki</creator><general>Springer Japan</general><general>Springer Nature B.V</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7QO</scope><scope>8FD</scope><scope>FR3</scope><scope>K9.</scope><scope>P64</scope><scope>7X8</scope></search><sort><creationdate>20200901</creationdate><title>Transcatheter aortic valve implantation-related futility: prevalence, predictors, and clinical risk model</title><author>Higuchi, Ryosuke ; Saji, Mike ; Hagiya, Kenichi ; Takamisawa, Itaru ; Shimizu, Jun ; Tobaru, Tetsuya ; Iguchi, Nobuo ; Takanashi, Shuichiro ; Takayama, Morimasa ; Isobe, Mitsuaki</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c399t-1fc59a10f4e9b5b6813eb8abb7eda58d182e1de5c345d4172003a8f5dadf7bcb3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2020</creationdate><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Aorta</topic><topic>Aortic valve</topic><topic>Aortic Valve - diagnostic imaging</topic><topic>Aortic Valve - physiopathology</topic><topic>Aortic Valve - surgery</topic><topic>Aortic Valve Stenosis - diagnostic imaging</topic><topic>Aortic Valve Stenosis - mortality</topic><topic>Aortic Valve Stenosis - physiopathology</topic><topic>Aortic Valve Stenosis - surgery</topic><topic>Biomedical Engineering and Bioengineering</topic><topic>Cardiac Surgery</topic><topic>Cardiology</topic><topic>Chronic obstructive pulmonary disease</topic><topic>Clinical Decision Rules</topic><topic>Confidence intervals</topic><topic>Congestive heart failure</topic><topic>Databases, Factual</topic><topic>Female</topic><topic>Heart Failure - diagnosis</topic><topic>Heart Failure - epidemiology</topic><topic>Heart Failure - mortality</topic><topic>Heart Failure - physiopathology</topic><topic>Heart valves</topic><topic>Humans</topic><topic>Implantation</topic><topic>Japan - epidemiology</topic><topic>Lung diseases</topic><topic>Male</topic><topic>Medical Futility</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Obstructive lung disease</topic><topic>Original Article</topic><topic>Patient Readmission</topic><topic>Patients</topic><topic>Performance prediction</topic><topic>Predictive Value of Tests</topic><topic>Prevalence</topic><topic>Regurgitation</topic><topic>Retrospective Studies</topic><topic>Rheumatic heart disease</topic><topic>Risk</topic><topic>Risk Assessment</topic><topic>Risk Factors</topic><topic>Statistical analysis</topic><topic>Thorax</topic><topic>Time Factors</topic><topic>Transcatheter Aortic Valve Replacement - adverse effects</topic><topic>Transcatheter Aortic Valve Replacement - mortality</topic><topic>Treatment Outcome</topic><topic>Vascular Surgery</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Higuchi, Ryosuke</creatorcontrib><creatorcontrib>Saji, Mike</creatorcontrib><creatorcontrib>Hagiya, Kenichi</creatorcontrib><creatorcontrib>Takamisawa, Itaru</creatorcontrib><creatorcontrib>Shimizu, Jun</creatorcontrib><creatorcontrib>Tobaru, Tetsuya</creatorcontrib><creatorcontrib>Iguchi, Nobuo</creatorcontrib><creatorcontrib>Takanashi, Shuichiro</creatorcontrib><creatorcontrib>Takayama, Morimasa</creatorcontrib><creatorcontrib>Isobe, Mitsuaki</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Biotechnology Research Abstracts</collection><collection>Technology Research Database</collection><collection>Engineering Research Database</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Biotechnology and BioEngineering Abstracts</collection><collection>MEDLINE - Academic</collection><jtitle>Heart and vessels</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Higuchi, Ryosuke</au><au>Saji, Mike</au><au>Hagiya, Kenichi</au><au>Takamisawa, Itaru</au><au>Shimizu, Jun</au><au>Tobaru, Tetsuya</au><au>Iguchi, Nobuo</au><au>Takanashi, Shuichiro</au><au>Takayama, Morimasa</au><au>Isobe, Mitsuaki</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Transcatheter aortic valve implantation-related futility: prevalence, predictors, and clinical risk model</atitle><jtitle>Heart and vessels</jtitle><stitle>Heart Vessels</stitle><addtitle>Heart Vessels</addtitle><date>2020-09-01</date><risdate>2020</risdate><volume>35</volume><issue>9</issue><spage>1281</spage><epage>1289</epage><pages>1281-1289</pages><issn>0910-8327</issn><issn>1615-2573</issn><eissn>1615-2573</eissn><abstract>Futility denotes failure to achieve the projected outcome. We investigated the prevalence, predictors, and clinical risk model of transcatheter aortic valve implantation (TAVI)-related futility. We included 464 consecutive patients undergoing TAVI from 2010 to 2017. Futility was defined as death and/or hospitalization for heart failure (HFH) within 1 year after TAVI. Of 464 patients (mean age: 84.4 years), 69% were females (EuroSCOREII: 6.3%; Society of Thoracic Surgeons [STS] score: 6.9%). Forty-six patients (9.9%) experienced TAVI-related futility, and 36 of 46 patients (69.6%) died within 1 year due to cardiac (37.5%) and non-cardiac (62.5%) causes. Previous HFH (hazard ratio [HR], 2.20; 95% confidence interval [CI]: 1.13–4.35,
p
= 0.020), chronic obstructive pulmonary disease (COPD) (HR, 3.39; 95% CI: 1.12–8.42,
p
= 0.033), and moderate/severe mitral or tricuspid regurgitation (HR, 2.98; 95% CI: 1.32–6.27,
p
= 0.010) were independent predictors of futility. With 1 point assigned to each predictor (total 0 point, futility low-risk; total 1 point, futility intermediate-risk; total 2–3 points, futility high-risk), the futility risk model clearly stratified individual futility risk into three groups (the freedom from futility at 1 year: 96.2%, 82.1%, and 67.9% each). Our futility risk model presented better discrimination than EuroSCOREII, and STS score (c-statistic: 0.73 vs. 0.68 vs. 0.67). Medical futility was recognized in 9.9% of patients undergoing TAVI. Previous HFH, COPD, and concomitant atrioventricular regurgitation were associated with futility. The risk model derived from three predictors showed good performance in predicting futility risk.</abstract><cop>Tokyo</cop><pub>Springer Japan</pub><pmid>32253528</pmid><doi>10.1007/s00380-020-01599-9</doi><tpages>9</tpages></addata></record> |
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| subjects | Aged Aged, 80 and over Aorta Aortic valve Aortic Valve - diagnostic imaging Aortic Valve - physiopathology Aortic Valve - surgery Aortic Valve Stenosis - diagnostic imaging Aortic Valve Stenosis - mortality Aortic Valve Stenosis - physiopathology Aortic Valve Stenosis - surgery Biomedical Engineering and Bioengineering Cardiac Surgery Cardiology Chronic obstructive pulmonary disease Clinical Decision Rules Confidence intervals Congestive heart failure Databases, Factual Female Heart Failure - diagnosis Heart Failure - epidemiology Heart Failure - mortality Heart Failure - physiopathology Heart valves Humans Implantation Japan - epidemiology Lung diseases Male Medical Futility Medicine Medicine & Public Health Obstructive lung disease Original Article Patient Readmission Patients Performance prediction Predictive Value of Tests Prevalence Regurgitation Retrospective Studies Rheumatic heart disease Risk Risk Assessment Risk Factors Statistical analysis Thorax Time Factors Transcatheter Aortic Valve Replacement - adverse effects Transcatheter Aortic Valve Replacement - mortality Treatment Outcome Vascular Surgery |
| title | Transcatheter aortic valve implantation-related futility: prevalence, predictors, and clinical risk model |
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