KCCQ Studied to Assess TAVR Mortality Risk

December 10, 2015—Suzanne V. Arnold, MD, et al conducted an investigation of the association of patient-reported health status with long-term mortality after transcatheter aortic valve replacement (TAVR) in the Society of Thoracic Surgeons (STS)/American College of Cardiology (ACC) Transcatheter Valve Therapy (TVT) Registry. The findings were published online ahead of print in Circulation: Cardiovascular Interventions.

The background of the study is that although TAVR is an effective treatment for aortic stenosis, long-term mortality after TAVR remains high and challenging to predict. The Kansas City Cardiomyopathy Questionnaire (KCCQ), which is assessed directly from patients, integrates two clinically relevant factors (symptoms and functional status) that may predict TAVR outcomes.

As summarized in Circulation: Cardiovascular Interventions, the study included 7,769 patients from 286 sites in the STS/ACC TVT Registry. The investigators examined the association between preprocedure (baseline) patient health status, as assessed by the KCCQ, and 1-year mortality after TAVR. 

The KCCQ overall summary score was categorized as very poor (< 25), poor (25–49), fair (50–74), or good (≥ 75). 

Before TAVR, health status was rated as very poor in 28% of patients, poor in 38%, fair in 24%, and good in 10%. Patients with worse health status were more likely to be women and had more comorbidities and higher STS mortality risk scores. Compared with those with good health status before TAVR and after adjusting for a range of baseline covariates, patients with very poor health status had a twofold increased hazard of death over the first year after TAVR (adjusted hazard ratio [HR], 2.00; 95% confidence interval [CI], 1.58–2.54). By contrast, patients with poor and fair health status had intermediate outcomes (adjusted HR, 1.54; 95% CI, 1.22–1.95; and adjusted HR, 1.2; 95% CI, 0.94–1.55, respectively).

In the national, contemporary practice cohort, worse preprocedure patient health status, as assessed by the KCCQ, was associated with greater long-term mortality after TAVR. These results from the STS/ACC TVT Registry support the measurement and integration of the KCCQ into mortality risk assessments for patients considering TAVR, concluded the investigators in Circulation: Cardiovascular Interventions.