Improvement in Risk Stratification in Transcatheter Aortic Valve Implantation Using a Combination of the Tumor Marker CA125 and the Logistic EuroSCORE.

Husser, Oliver; Núñez, Julio; Burgdorf, Christof; Holzamer, Andreas; Templin, Christian; Kessler, Thorsten; Bodi, Vicente; Sanchis, Juan; Pellegrini, Costanza; Luchner, Andreas; Maier, Lars S; Schmid, Christof; Lüscher, Thomas F; Schunkert, Heribert; Kastrati, Adnan; Hilker, Michael; Hengstenberg, Christian

doi:10.1016/j.rec.2016.08.004

2017

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Titel:: Improvement in Risk Stratification in Transcatheter Aortic Valve Implantation Using a Combination of the Tumor Marker CA125 and the Logistic EuroSCORE.
Dokumenttyp:: Journal Article; Observational Study; Article
Autor(en):: Husser, Oliver; Núñez, Julio; Burgdorf, Christof; Holzamer, Andreas; Templin, Christian; Kessler, Thorsten; Bodi, Vicente; Sanchis, Juan; Pellegrini, Costanza; Luchner, Andreas; Maier, Lars S; Schmid, Christof; Lüscher, Thomas F; Schunkert, Heribert; Kastrati, Adnan; Hilker, Michael; Hengstenberg, Christian
Abstract:: 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.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).CA125 offers additional prognostic information beyond that obtained by the EuroSCORE. Elevation of both markers was associated with a poor prognosis.
Zeitschriftentitel:: Rev Esp Cardiol (Engl Ed)
Jahr:: 2017
Band / Volume:: 70
Heft / Issue:: 3
Seitenangaben Beitrag:: 186-193
Sprache:: eng
Volltext / DOI:: doi:10.1016/j.rec.2016.08.004
PubMed:: http://view.ncbi.nlm.nih.gov/pubmed/27623490
TUM Einrichtung:: Klinik für Herz- und Kreislauferkrankungen im Erwachsenenalter (Prof. Schunkert)
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mediaTUM Gesamtbestand Einrichtungen Schools TUM School of Medicine and Health Departments Clinical Medicine Lehr- und Forschungskooperationen mit den Kliniken und Instituten am Deutschen Herzzentrum Klinik für Herz- und Kreislauferkrankungen im Erwachsenenalter (DHM) (Prof. Schunkert)2017