Background

Current risk models show limited performances for predicting all-cause mortality after transcatheter aortic valve replacement (TAVR).

Purpose

To determine the prognostic value of coronary artery calcium (CAC) scoring for predicting 30-day and 1-year mortality in patients undergoing TAVR.

Materials and Methods

In this single-center institutional review board–approved secondary analysis of prospectively collected data (SwissTAVI Registry), the authors evaluated participants who, before TAVR, underwent CT that included a nonenhanced electrocardiography-gated cardiac scan between May 2008 and September 2019 and who had not undergone previous coronary revascularization. Clinical data, including the European System for Cardiac Operative Risk Evaluation (EuroSCORE II), were recorded. The CAC score was determined, and 30-day and 1-year all-cause mortality were assessed by using Cox regression analyses.

Results

In total, 309 participants (mean age ± standard deviation, 81 years ± 7; 175 women) were included, with a median CAC score of 334 (interquartile range, 104–987). Seventy-seven of the 309 participants (25%) had a CAC score greater than or equal to 1000. A CAC score of 1000 or greater served as an independent predictor of 30-day (hazard ratio [HR], 4.5 [95% CI: 1.5, 13.6] compared with a CAC score <1000; P = .007) and 1-year (HR, 4.3 [95% CI: 1.5, 12.7] compared with a CAC score of 0–99; P = .008) mortality after TAVR. Similar trends were observed for each point increase of the EuroSCORE II as an independent predictor of 30-day (HR, 1.22 [95% CI: 1.10, 1.36]; P < .001) and 1-year (HR, 1.16 [95% CI: 1.08, 1.25]; P < .001) mortality. Adding the CAC score to the EuroSCORE II provided incremental prognostic value for 1-year mortality after TAVR over the EuroSCORE II alone (concordance index, 0.76 vs 0.69; P = .04).

Conclusion

In participants without prior coronary revascularization, the coronary artery calcium score represented an independent predictor of 30-day and 1-year mortality after transcatheter aortic valve replacement.

ClinicalTrials.gov identifier, NCT01368250

© RSNA, 2021

Online supplemental material is available for this article.

See also the editorial by Almeida in this issue.

中文翻译：

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冠状动脉钙化评分对预测经导管主动脉瓣置换术后全因死亡率的增量预后价值

背景

当前的风险模型在预测经导管主动脉瓣置换术 (TAVR) 后的全因死亡率方面表现有限。

目的

确定冠状动脉钙化 (CAC) 评分对预测 TAVR 患者 30 天和 1 年死亡率的预后价值。

材料和方法

在这个单中心机构审查委员会批准的前瞻性收集数据的二次分析（SwissTAVI Registry）中，作者评估了在 TAVR 之前接受 CT 包括非增强心电图门控心脏扫描在 2008 年 5 月至 2019 年 9 月期间的参与者。既往未接受冠状动脉血运重建术。记录了临床数据，包括欧洲心脏手术风险评估系统 (EuroSCORE II)。确定 CAC 评分，并使用 Cox 回归分析评估 30 天和 1 年全因死亡率。

结果

总共包括 309 名参与者（平均年龄 ± 标准差，81 岁 ± 7 岁；175 名女性），CAC 得分中位数为 334（四分位距，104-987）。309 名参与者中有 77 人 (25%) 的 CAC 评分大于或等于 1000。CAC 评分为 1000 或更高作为 30 天的独立预测因子（风险比 [HR]，4.5 [95% CI ：1.5, 13.6] 与 CAC 评分 <1000；P = .007）和 1 年（HR，4.3 [95% CI：1.5, 12.7] 与 CAC 评分 0-99 相比；P = .008） TAVR 后死亡率。作为 30 天（HR，1.22 [95% CI：1.10, 1.36]；P < .001）和 1 年（HR，1.16 [95% CI: 1.08, 1.25]; P< .001) 死亡率。与 EuroSCORE II 相比，将 CAC 评分添加到 EuroSCORE II 中提供了 TAVR 后 1 年死亡率的增量预后价值（一致性指数，0.76 对 0.69；P = .04）。

结论

在先前未进行冠状动脉血运重建的参与者中，冠状动脉钙化评分代表了经导管主动脉瓣置换术后 30 天和 1 年死亡率的独立预测因子。

ClinicalTrials.gov 标识符，NCT01368250

©北美放射学会，2021

本文提供了在线补充材料。

另请参阅本期 Almeida 的社论。