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Revista Española de Cardiología (English Edition) Revista Española de Cardiología (English Edition)
Rev Esp Cardiol. 2017;70:186-93 - Vol. 70 Num.03 DOI: 10.1016/j.rec.2016.08.004

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

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

a Klinik für Herz- und Kreislauferkrankungen, Deutsches Herzzentrum München, Munich, Germany
b Klinik und Poliklinik für Innere Medizin II, Universitätsklinikum Regensburg, Regensburg, Germany
c Departamento de Cardiología, Hospital Clínico Universitario de Valencia, Instituto de Investigación Sanitaria INCLIVA, Universidad de Valencia, Valencia, Spain
d Klinik für Herz-, Thorax-, und herznahe Gefäßchirurgie, Universitätsklinikum Regensburg, Regensburg, Germany
e Universitäres Herzzentrum, Kardiologie, Universitätsspital Zu¿rich, Zurich, Switzerland
f Deutsches Zentrum fu¿r Herz-Kreislauf-Forschung e.V., Partner Site Munich Heart Alliance, Munich, Germany

Keywords

Transcatheter aortic valve implantation. Tumor marker carbohydrate antigen 125. Logistic EuroSCORE. Risk prediction.

Abstract

Introduction and objectives

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.

Methods and 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.

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1885-5857/© 2017 Sociedad Española de Cardiología. Published by Elsevier España, S.L.U. All rights reserved