High C-reactive protein (CRP) and low high-density lipoprotein cholesterol (HDL-C) levels at baseline were found to predict all-cause mortality in elderly patients who underwent transcatheter aortic valve implantation (TAVI), according to study results published in The American Journal of Cardiology.
Current outcome prediction models often fail to account for risk factors frequently seen in the elderly population, and are often inaccurate when applied to individuals who have undergone TAVI. Investigators sought to assess the prognostic value of 2 laboratory parameters recognized to correlate with cardiovascular and non-cardiovascular mortality in the general population.
In this study, the data of 334 patients (median age, 81 years; 63.2% women; high-risk, 67.8%) who underwent TAVI between January 2010 and July 2017 and had available baseline HDL-C and CRP measurements were examined.
Low levels of HDL-C (ie, ≤46 mg/dL) and high levels of CRP (ie, ≥0.20 mg/dL) at baseline were each found to predict 2-year all-cause mortality in a receiver operating characteristic curve analysis (area under the curve: 0.657 and 0.634, respectively; P <.001 for both). Patients with low HDL-C and high CRP levels were found to be at high risk according to European System for Cardiac Operative Risk Evaluation (EuroSCORE) II criteria, with a high frequency of individuals with these combined characteristics having left ventricular ejection fraction (LVEF) ≤50%. Fewer patients with elevated CRP and normal HDL-C vs high CRP/low HDL-C had LVEF ≤50%, but these individuals had a greater prevalence of sarcopenia.
Participants with low HDL-C and high CRP levels had the highest 2-year mortality rate (42.5%). The mortality rates in individuals with low HDL-C or high CRP had were 22.5% and 20.2%, respectively. Two-year mortality was found to be independently predicted by isolated low HDL-C (n=40; hazard ratio [HR], 2.92; 95% CI, 1.05-8.13; P =.040) or isolated high CRP (n=109; HR, 2.42; 95% CI, 1.05-5.60; P =.039) in multivariable analyses adjusted for known mortality predictors such as statin use and EuroSCORE II. The mortality risk was highest in individuals with both low HDL-C levels and high CRP levels (HR, 4.53; 95% CI, 1.96-10.50; P <.001). Other significant predictors of mortality included male sex, statin treatment, chronic kidney disease, and EuroSCORE II.
Increased CRP levels were associated with higher mortality during the first-year (HR, 2.68; 95% CI, 1.27-5.64; P =.009), and lower HDL-C levels were associated with higher mortality rates during the second year of follow-up (HR, 4.20; 95% CI, 1.91-9.25; P <.001). When both biomarkers were combined with EuroSCORE II, 2-year mortality prediction was enhanced (area under the curve, 0.697).
Study limitations include the small sample size, lack of data on direct causes of death, and the retrospective design that precludes causal analysis.
“Patients with low HDL-C and high CRP had substantially increased 2-year mortality (42.5%), potentially representing a therapeutic group who might gain more from intensive medical treatment,” noted the authors.
Funding and Conflicts of Interest Disclosures
GSM has received honoraria from Boston Scientific, Philips, Medtronic, and Terumo. MDab has received a speaker’s honoraria from Boston Scientific and personal fees from Boston Scientific, Medtronic and Edwards Lifesciences. AW is a proctor of Medtronic and Edwards Lifesciences and has received a speaker’s honoraria from Abbott, Boston Scientific and Edwards Lifesciences.
Zieliński K, Kalińczuk Ł, Chmielak Z, et al. Additive value of high-density lipoprotein cholesterol and C-reactive protein level assessment for prediction of 2-year mortality after transcatheter aortic valve implantation. Am J Cardiol. April 2020. doi:10.1016/j.amjcard.2020.03.037