Abstract 12052: Multimarker Approach for Risk Stratification in Patients Undergoing Transcatheter Aortic Valve Implantation

Introduction: Transcatheter aortic valve implantation (TAVI) is an alternative to surgical aortic valve replacement for the treatment of severe aortic stenosis (AS). However, TAVI may be futile in a substantial proportion of patients. The development of a blood multimarker approach encompassing cardiac damage, inflammation, cancer, and renal function could be useful to accurately identify patients who may benefit from TAVI versus those who may not. Hypothesis: the objective of this study was to examine the association between blood biomarkers and all-cause mortality following TAVI. Methods: Three hundred and sixty-three patients who underwent TAVI at our institution were prospectively recruited. Clinical and echocardiographic data were collected. Nine biomarkers were measured from blood samples collected before TAVI. The cohort was divided in 3 groups according to the number of elevated biomarkers (i.e ≥median of the cohort) per patients. Multivariable survival analysis was performed to evaluate the association between biomarkers and all-cause mortality. The incremental prognostic value of the biomarkers model to predict all-cause mortality was assessed using the net reclassification index (NRI). Results: In comparison with patients with 0-3 elevated biomarkers, those with 4-7 and 8-9 were older, had more comorbidities and higher rate of NYHA ≥III. They also had longer hospital stay following TAVI. During a median follow-up of 2.5 (1.9-3.2) years, 99 (27%) patients died. Using multivariable Cox analysis and patients with 0-3 elevated biomarkers as the referent group, those with 4-7 and 8-9 elevated biomarkers had a higher risk of all-cause mortality (HR [95%CI]: 1.83 [1.01-3.38], p=0.05, and HR [95%CI]: 4.09 [2.16-7.76], p<0.001, respectively). The addition of the number of elevated blood biomarkers provided important incremental prognostic value in comparison with the clinical model (NRI=0.71, p<0.001). Conclusions: An increasing number of elevated biomarkers was associated with higher risk of mortality after adjustment for baseline differences. Moreover, the biomarker model provided important incremental prognostic value beyond the clinical variables and could thus enhance risk stratification of patients undergoing TAVI.