Comparison of multiparametric risk scores for predicting early mortality after transcatheter aortic valve implantation

Carmo, J. P.; Teles, Rui Campante; Madeira, Sérgio; Ferreira, Antonio M.; Brito, João; Nolasco, Tiago; Gonçalves, Pedro de Araújo; Gabriel, Henrique Mesquita; Raposo, Luís; Vale, Nélson; Ribeiras, Regina; Abecasis, Miguel; Almeida, Manuel; Neves, José Pedro; Mendes, Miguel

doi:10.1016/j.repce.2018.07.002

Cited by 3 publications

(4 citation statements)

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“…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).…”

Section: Search Resultsmentioning

confidence: 99%

Section: Predictors Of Short-term Mortalitymentioning

confidence: 99%

“…Globally, in the last few years, TAVR has been performed in more than 400,000 patients and indications keep growing at a rate of 40% annually 27 . This has presented the need for RSMs that can predict 30-day mortality, thereby allowing patient selection and provider comparisons 27 . Due to the lack of TAVR-specific models initially, several investigators tested the usefulness of surgical RSMs in assessing the risk of mortality in patients undergoing TAVR.…”

Section: Predictors Of Short-term Mortalitymentioning

confidence: 99%

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

Siddiqi¹,

Usman²,

Khan³

et al. 2020

EuroIntervention

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Aims:The aim of this study was to evaluate the performance of risk stratification models (RSMs) in predicting short-term mortality after transcatheter aortic valve replacement (TAVR).Methods and results: MEDLINE and Scopus were queried to identify studies which validated RSMs designed to assess 30-day or in-hospital mortality after TAVR. Discrimination and calibration were assessed using C-statistics and observed/expected ratios (OERs), respectively. C-statistics were pooled using a random-effects inverse-variance method, while OERs were pooled using the Peto odds ratio. A good RSM is defined as one with a C-statistic >0.7 and an OER close to 1.0. Twenty-four studies (n=68,215 patients) testing 11 different RSMs were identified. Discrimination of all RSMs was poor (C-statistic <0.7); however, certain TAVR-specific RSMs such as the in-hospital STS/ACC TVT (C-statistic=0.65) and STT (C-statistic=0.66) predicted individual mortality more reliably than surgical models (C-statistic range=0.59-0.61). A good calibration was demonstrated by the in-hospital STS/ACC TVT (OER=0.99), 30-day STS/ACC TVT (OER=1.08) and STS (OER=1.01) models. Baseline dialysis (OER: 2.64 [1.88, 3.70]; p<0.001) was the strongest predictor of mortality.Conclusions: This study demonstrates that the STS/ACC TVT model (in-hospital and 30-day) and the STS model have accurate calibration, making them useful for comparison of centre-level risk-adjusted mortality. In contrast, the discriminative ability of currently available models is limited.

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Section: Search Resultsmentioning

confidence: 99%

Section: Predictors Of Short-term Mortalitymentioning

confidence: 99%

Section: Predictors Of Short-term Mortalitymentioning

confidence: 99%

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

Siddiqi¹,

Usman²,

Khan³

et al. 2020

EuroIntervention

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“…As expected, 30‐day all‐cause mortality was low (2.5%) and similar between groups, but slightly higher than the one predicted by the ES II—2.1% for SAVR and 2.4% for TAVI matched patients. While being recommended for risk evaluation, 4 the ES II has previously been shown to have a modest performance in early mortality prediction after TAVI, despite not being surpassed by other scores specifically derived from TAVI populations such as the FRANCE‐2 score 8 . The observed higher‐than‐predicted short‐term mortality captures the real cohort risk and recalls for the need to assess other factors besides risk scores during individual patient evaluation, as done by our Heart Team and described on Table 3.…”

Section: Discussionmentioning

confidence: 99%

Surgical versus transcatheter aortic valve replacement in low‐risk patients: A long‐term propensity score‐matched analysis

Brízido

Madeira

Brito

et al. 2021

Cathet Cardio Intervent

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Background Recent studies suggest the use of transcatheter aortic valve implantation (TAVI) as an alternative to surgical aortic valve replacement (SAVR) in lower risk populations, but real‐world data are scarce. Methods Single‐center retrospective study of patients undergoing SAVR (between June 2009 and July 2016, n = 682 patients) or TAVI (between June 2009 and July 2017, n = 400 patients). Low surgical risk was defined as EuroSCORE II (ES II) < 4% for single noncoronary artery bypass graft procedure. TAVI patients were propensity score‐matched in a 1:1 ratio with SAVR patients, paired by age, New York Heart Association class, diabetes mellitus, chronic obstructive pulmonary disease, atrial fibrillation, creatinine clearance, and left ventricular ejection fraction < 50%. Results A total of 158 patients (79 SAVR and 79 TAVI) were matched (mean age 79 ± 6 years, 79 men). TAVI patients had a higher incidence of permanent pacemaker implantation (0% vs. 19%, p < 0.001) and more than mild paravalvular leak (4% vs. 18%, p = 0.009), but comparable rates of stroke, major or life‐threatening bleeding, emergent cardiac surgery, new‐onset atrial fibrillation, and need for renal replacement therapy. Hospital length‐of‐stay and 30‐day mortality were similar. At a median follow‐up of 4.5 years (IQR 3.0–6.9), treatment strategy did not influence all‐cause mortality (HR 1.19, 95% CI 0.77–1.83, log rank p = 0.43) nor rehospitalization (crude subdistribution HR 1.56, 95% CI 0.71–3.41, p = 0.26). ES II remained the only independent predictor of long‐term all‐cause mortality (adjusted HR 1.40, 95% CI 1.04–1.90, p = 0.029). Conclusion In this low surgical risk severe aortic stenosis population, we observed similar rates of 30‐day and long‐term all‐cause mortality, despite higher rates of permanent pacemaker implantation and more than mild paravalvular leak in TAVI patients. The results of this small study suggest that both procedures are safe and effective in the short‐term, while the Heart Team remains essential to assess both options on the long‐term.

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TAVR: A Review of Current Practices and Considerations in Low-Risk Patients

Spears

Al-Saiegh

Goldberg

et al. 2020

Journal of Interventional Cardiology

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Transcatheter aortic valve replacement (TAVR) is an established treatment for severe, symptomatic, aortic stenosis (AS) in patients of all risk categories and now comprises 12.5% of all aortic valve replacements. TAVR is a less invasive alternative to traditional surgical aortic valve replacement (SAVR), with equivalent or superior outcomes. The use of TAVR has increased rapidly. The success and increase in use of TAVR are a result of advances in technology, greater operator experience, and improved outcomes. Indications have recently expanded to include patients considered to be at low risk for SAVR. While TAVR outcomes have improved, remaining challenges include the management of coexistent coronary artery disease, prevention of periprocedural stroke, and issue of durability. These issues are even more relevant for low-risk, younger patients.

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Comparison of multiparametric risk scores for predicting early mortality after transcatheter aortic valve implantation

Cited by 3 publications

References 23 publications

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

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

Surgical versus transcatheter aortic valve replacement in low‐risk patients: A long‐term propensity score‐matched analysis

TAVR: A Review of Current Practices and Considerations in Low-Risk Patients

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