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Original research article
Association of comorbid burden with clinical outcomes after transcatheter aortic valve implantation
  1. Rodrigo Bagur1,2,3,
  2. Glen Philip Martin4,
  3. Luis Nombela-Franco5,
  4. Sagar N Doshi6,
  5. Sudhakar George6,
  6. Stefan Toggweiler7,
  7. Sandro Sponga8,
  8. James M Cotton9,
  9. Saib S Khogali9,
  10. Karim Ratib3,
  11. Tim Kinnaird10,
  12. Richard A Anderson10,
  13. Michael W A Chu1,
  14. Bob Kiaii1,
  15. Corina Biagioni5,
  16. Lois Schofield-Kelly9,
  17. Lucca Loretz7,
  18. Leonardo Torracchi8,
  19. Baskar Sekar10,
  20. Chun Shing Kwok3,
  21. Matthew Sperrin4,
  22. Peter F Ludman6,
  23. Mamas A Mamas3,4
  1. 1 Heart Team, London Health Sciences Centre, London, Ontario, Canada
  2. 2 Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
  3. 3 Keele Cardiovascular Research Group, Centre for Prognosis Research, Institute for Primary Care and Health Sciences, Keele University, Stoke-on-Trent, UK
  4. 4 Farr Institute, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
  5. 5 Cardiovascular Institute, Hospital Clínico San Carlos, Madrid, Spain
  6. 6 Cardiology Department, Queen Elizabeth Hospital, Birmingham, UK
  7. 7 Cardiology Division, Heart Center Lucerne, Lucerne, Switzerland
  8. 8 Cardiothoracic Department, University Hospital of Udine, Udine, Italy
  9. 9 The Heart and Lung Centre, The Royal Wolverhampton Hospitals NHS Trust, Wolverhampton, UK
  10. 10 Department of Cardiology, University Hospital of Wales, Cardiff, UK
  1. Correspondence to Dr Rodrigo Bagur, London Health Sciences Centre, London, ON N6A 5A5, Canada; rodrigobagur{at}


Objectives To investigate the association of the CharlsonComorbidity Index (CCI) with clinical outcomes after transcatheter aortic valve implantation (TAVI).

Background Patients undergoing TAVI have high comorbid burden; however, there is limited evidence of its impact on clinical outcomes.

Methods Data from 1887 patients from the UK, Canada, Spain, Switzerland and Italy were collected between 2007 and 2016. The association of CCI with 30-day mortality, Valve Academic Research Consortium-2 (VARC-2) composite early safety, long-term survival and length of stay (LoS) was calculated using logistic regression and Cox proportional hazard models, as a whole cohort and at a country level, through a two-stage individual participant data (IPD) random effect meta-analysis.

Results Most (60%) of patients had a CCI ≥3. A weak correlation was found between the total CCI and four different preoperative risks scores (ρ=0.16 to 0.29), and approximately 50% of patients classed as low risk from four risk prediction models still presented with a CCI ≥3. Per-unit increases in total CCI were not associated with increased odds of 30-day mortality (OR 1.09, 95% CI 0.96 to 1.24) or VARC-2 early safety (OR 1.04, 95% CI 0.96 to 1.14) but were associated with increased hazard of long-term mortality (HR 1.10, 95% CI 1.05 to 1.16). The two-stage IPD meta-analysis indicated that CCI was not associated with LoS (HR 0.97, 95% CI 0.93 to 1.02).

Conclusion In this multicentre international study, patients undergoing TAVI had significant comorbid burden. We found a weak correlation between the CCI and well-established preoperative risks scores. The CCI had a moderate association with long-term mortality up to 5 years post-TAVI.

  • transcatheter valve interventions
  • aortic and arterial disease
  • aortic stenosis
  • epidemiology

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  • RB and GPM contributed equally.

  • Contributors RB, GPM and MAM: (1) conception and design, acquisition, analysis and interpretation of data; (2) drafting of the manuscript; and (3) final approval of the manuscript submitted. CB, LS-K, LL, LT, BS and CSK: (1) acquisition and interpretation of data; (2) revising critically the manuscript for important intellectual content; and (3) final approval of the manuscript submitted. LN-F, SND, SG, ST, SS, JMC, SSK, KR, TK, RAA, MWAC, BK, MS and PFL: (1) analysis and interpretation of data; (2) revising critically the manuscript for important intellectual content; and (3) final approval of the manuscript submitted. All authors have read the manuscript and approved the submission to Heart. The corresponding author has the right to grant on behalf of all authors and does grant on behalf of all authors an exclusive licence (or non-exclusive for government employees) on a worldwide basis to the BMJ Publishing Group Ltd and its licensees to permit this article (if accepted) to be published in Heart editions and any other BMJPGL products to exploit all subsidiary rights.

  • Funding This work was partially funded by the Medical Research Council through the Health e-Research Centre, University of Manchester (MR/K006665/1).

  • Competing interests None declared.

  • Patient consent Not required.

  • Ethics approval Individual centre/local institutions.

  • Provenance and peer review Not commissioned; externally peer reviewed.