Prognostic Impact of Prefrailty and Frailty in Women Undergoing TAVR: Insights From the WIN-TAVI Registry

• DOI: 10.1016/j.cjca.2023.10.024
• Publication Date: 2023-11-01T21:51:32Z
• Authors: Marija Petrovic; Alessandro Spirito; Samantha Sartori; Birgit Vogel; Didier Tchetche; Anna Sonia Petronio; Julinda Mehilli; Thierry Lefevre; Patrizia Presbitero; Piera Capranzano; Brunna Pileggi; Alessandro Iadanza; Gennaro Sardella; Nicolas M. van Mi...; Emanuele Meliga; Yihan Feng; Nicolas Dumonteil; Rebecca Cohen; Chiara Fraccaro; Daniela Trabattoni; Ghada Mikhail; Maria-Cruz Ferrer...; Christoph Naber; Samin K. Sharma; Yusuke Watanabe; Marie-Claude Morice; George D. Dangas; Alaide Chieffo; Roxana Mehran

The risks of pre-frail and frail women undergoing transcatheter aortic valve replacement (TAVR) have not been fully examined. The aim of the analysis was to assess the prognostic impact of pre-frailty and frailty in women undergoing TAVR.Women at intermediate or high surgical risk with severe aortic stenosis undergoing TAVR from the prospective multicenter WIN-TAVI (Women's International transcatheter aortic valve implantation registry) were stratified based on the number of Fried frailty criteria (weight loss, exhaustion, low physical activity, slow gait, weakness) met in: non-frail (no criteria); prefrail (1-2 criteria); or frail (≥3 criteria). The primary outcome at 1-year was the valve academic research consortium-2 (VARC-2) efficacy endpoint, a composite of mortality, stroke, myocardial infarction, hospitalization for valve-related symptoms or heart failure, or valve-related dysfunction; secondary outcomes included the composite of VARC-2 life-threatening or major bleeding.Out of 1,019 women, 297 (29.1%) met at least one frailty criterion, 264 (25.9%) had prefrailty and 33 (3.2%) frailty. The 1-year risk of the primary outcome was significantly higher in prefrail or frail (20.2%) as compared to non-frail (14.9%) women (adj.HR 1.51, 95% CI 1.07-2.12). The risk of VARC-2 life-threatening or major bleeding was higher in prefrail or frail (19.9%) than non-frail (10.0%) women (adj.HR 2.06, 95% CI 1.42-2.97). These risks were consistently increased in the pre-frail and frail groups assessed separately.In women undergoing TAVR, the presence of prefrailty or frailty conferred an increased risk of the VARC-2 efficacy endpoint and of VARC-2 life-threatening or major bleeding.