Gait Speed Predicts 30-Day Mortality After Transcatheter Aortic Valve Replacement: Results From the Society of Thoracic Surgeons/American College of Cardiology Transcatheter Valve Therapy Registry

Circulation. 2016 Apr 5;133(14):1351-9. doi: 10.1161/CIRCULATIONAHA.115.020279. Epub 2016 Feb 26.

Abstract

Background: Surgical risk scores do not include frailty assessments (eg, gait speed), which are of particular importance for patients with severe aortic stenosis considering transcatheter aortic valve replacement.

Methods and results: We assessed the association of 5-m gait speed with outcomes in a cohort of 8039 patients who underwent transcatheter aortic valve replacement (November 2011-June 2014) and were included in the Society of Thoracic Surgeons/American College of Cardiology Transcatheter Valve Therapy Registry. We evaluated the association between continuous and categorical gait speed and 30-day all-cause mortality before and after adjustment for Society of Thoracic Surgeons-predicted risk of mortality score and key variables. Secondary outcomes included in-hospital mortality, bleeding, acute kidney injury, and stroke. The overall median gait speed was 0.63 m/s (25th-75th percentile, 0.47-0.79 m/s), with the slowest walkers (<0.5 m/s) constituting 28%, slow walkers (0.5-0.83 m/s) making up 48%, and normal walkers (>0.83 m/s) constituting 24% of the population. Thirty-day all-cause mortality rates were 8.4%, 6.6%, and 5.4% for the slowest, slow, and normal walkers, respectively (P<0.001). Each 0.2-m/s decrease in gait speed corresponded to an 11% increase in 30-day mortality (adjusted odds ratio, 1.11; 95% confidence interval, 1.01-1.22). The slowest walkers had 35% higher 30-day mortality than normal walkers (adjusted odds ratio, 1.35; 95% confidence interval, 1.01-1.80), significantly longer hospital stays, and a lower probability of being discharged to home.

Conclusions: Gait speed is independently associated with 30-day mortality after transcatheter aortic valve replacement. Identification of frail patients with the slowest gait speeds facilitates preprocedural evaluation and anticipation of a higher level of postprocedural care.

Clinical trial registration: URL: http://www.clinicaltrials.gov. Unique identifier: NCT01737528.

Keywords: aged; aortic valve stenosis; heart valve diseases; transcatheter aortic valve replacement.

Publication types

  • Comparative Study
  • Observational Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Acute Kidney Injury / epidemiology
  • Aged
  • Aged, 80 and over
  • Female
  • Frail Elderly / statistics & numerical data
  • Gait*
  • Hospital Mortality
  • Humans
  • Male
  • Mobility Limitation*
  • Postoperative Complications / epidemiology*
  • Postoperative Complications / mortality
  • Postoperative Hemorrhage / epidemiology
  • Prognosis
  • Prospective Studies
  • Registries / statistics & numerical data
  • Stroke / epidemiology
  • Transcatheter Aortic Valve Replacement / mortality*

Associated data

  • ClinicalTrials.gov/NCT01737528