Performance of Surgical Risk Scores to Predict Mortality after Transcatheter Aortic Valve Implantation

Abstract

BackgroundPredicting mortality in patients undergoing transcatheter aortic valve implantation (TAVI) remains a challenge.ObjectivesTo evaluate the performance of 5 risk scores for cardiac surgery in predicting the 30-day mortality among patients of the Brazilian Registry of TAVI.MethodsThe Brazilian Multicenter Registry prospectively enrolled 418 patients undergoing TAVI in 18 centers between 2008 and 2013. The 30-day mortality risk was calculated using the following surgical scores: the logistic EuroSCORE I (ESI), EuroSCORE II (ESII), Society of Thoracic Surgeons (STS) score, Ambler score (AS) and Guaragna score (GS). The performance of the risk scores was evaluated in terms of their calibration (Hosmer–Lemeshow test) and discrimination [area under the receiver–operating characteristic curve (AUC)].ResultsThe mean age was 81.5 ± 7.7 years. The CoreValve (Medtronic) was used in 86.1% of the cohort, and the transfemoral approach was used in 96.2%. The observed 30-day mortality was 9.1%. The 30-day mortality predicted by the scores was as follows: ESI, 20.2 ± 13.8%; ESII, 6.5 ± 13.8%; STS score, 14.7 ± 4.4%; AS, 7.0 ± 3.8%; GS, 17.3 ± 10.8%. Using AUC, none of the tested scores could accurately predict the 30-day mortality. AUC for the scores was as follows: 0.58 [95% confidence interval (CI): 0.49 to 0.68, p = 0.09] for ESI; 0.54 (95% CI: 0.44 to 0.64, p = 0.42) for ESII; 0.57 (95% CI: 0.47 to 0.67, p = 0.16) for AS; 0.48 (95% IC: 0.38 to 0.57, p = 0.68) for STS score; and 0.52 (95% CI: 0.42 to 0.62, p = 0.64) for GS. The Hosmer–Lemeshow test indicated acceptable calibration for all scores (p > 0.05).ConclusionsIn this real world Brazilian registry, the surgical risk scores were inaccurate in predicting mortality after TAVI. Risk models specifically developed for TAVI are required.

Systematic review and meta-analysis of current risk models in predicting short-term mortality after transcatheter aortic valve replacement

“…Utility of conventional surgical risk scores in predicting outcome after transcatheter aortic valve replacement, presented at American College of Cardiology (ACC) 2013 Scientific Sessions, 9 March 2013, San Francisco, CA, USA). A total of 68,125 patients from these studies were included in the analysis (Figure 1) [4][5][6][7][8][9][10][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29] . These 24 studies tested 11 different RSMs (7 TAVR-specific, 3 surgical, and 1 designed for use in both TAVR and SAVR patients).…”

Bridging gaps in heart valve disease care: Opportunities for quality improvement

“…The EuroSCORE II and the STS score are widely supported as the preferred operative risk assessment instruments . Other evidence‐supported tools that help clinicians assess risks associated with cardiovascular treatment options include: Survival post TAVI score Sarcopenia Multidimensional geriatric assessment tools: gait speed and grip strength Norton scale Ambler score TAVR in‐hospital mortality risk calculator Patient decision aids : The national valvular heart disease guidelines recommend a shared decision‐making approach. Several research studies recommend the use of decision‐making tools to help patients select treatment options .…”

Rockwood Clinical Frailty Scale as a predictor of adverse outcomes among older adults undergoing aortic valve replacement: a protocol for a systematic review

“…Current widely used risk scores for aortic valve procedures include the Society of Thoracic Surgeons (STS) risk score and the European System for Cardiac Operative Risk Evaluation (EuroSCORE), 24 25 both of which were developed in the SAVR population. These appear to correlate poorly with mortality following TAVR, 26 27 giving rise to the development of newer, more specific TAVR risk scores. 28–30 Neither the STS Score nor the EuroSCORE include an objective measurement of frailty though assessing frailty has the potential to improve their predictive performance, particularly in older adults.…”