Carbohydrate antigen 125 as a predictor of mortality and heart failure outcomes after transcatheter aortic valve implantation: a systematic review and meta-analysis
D Chirino, C S Laurenzano, A Diaz Casale, C Dizeo, G CalderonAbstract
Background
Risk stratification in patients undergoing transcatheter aortic valve implantation (TAVI) remains challenging. Traditional risk models, developed primarily for surgical populations, may not adequately capture key pathophysiological drivers of outcomes in this setting, such as systemic congestion and inflammation. Carbohydrate antigen 125 (CA-125), a biomarker associated with congestion and adverse outcomes in heart failure, has been explored as a prognostic marker in patients with severe aortic stenosis undergoing TAVI. However, available evidence remains heterogeneous, and its clinical utility has not been conclusively defined.
Purpose
To perform a systematic review and meta-analysis of available evidence to determine the association between elevated baseline CA-125 levels and clinical outcomes in patients undergoing TAVI.
Methods
We conducted a systematic review of observational studies evaluating the prognostic role of baseline CA-125 in patients undergoing TAVI. Only studies reporting multivariable-adjusted hazard ratios (HRs) for either all-cause mortality or a composite outcome (all-cause mortality and/or heart failure rehospitalization) were included. Study quality was assessed using the Quality in Prognosis Studies (QUIPS) tool. Adjusted HRs were pooled using a random-effects model, and heterogeneity was assessed using the I² statistic.
Results
Five observational studies comprising 1,251 patients met inclusion criteria. Overall methodological quality ranged from low to moderate risk of bias according to QUIPS assessment. Three studies reported adjusted HRs for all-cause mortality. Elevated baseline CA-125 levels were independently associated with increased mortality risk (pooled HR 2.18, 95% CI 1.60–2.96; I² = 0%).Three studies evaluated a composite endpoint of mortality and/or heart failure rehospitalization. Elevated CA-125 was significantly associated with adverse outcomes (pooled HR 2.27, 95% CI 1.56–3.28; I² = 0%). No statistical heterogeneity was observed across analyses.
Conclusions
This meta-analysis shows that elevated preprocedural CA-125 is independently associated with a twofold increased risk of mortality and composite adverse outcomes following TAVI. These findings support the potential role of CA-125 as an adjunctive biomarker for risk stratification in this population. Prospective studies are warranted to determine its incremental value beyond established risk models.aHR All cause MortalityaHR composite end point