Key result
TVT and STS risk scores poorly predict 30-day and 1-year mortality in all-risk TAVR patients.
Why the study?
The TVT score was developed to predict in-hospital mortality in high- or prohibitive-risk patients, but its performance in low- and intermediate-risk patients undergoing TAVR is unknown.
Does the TVT risk score improve prediction of 30-day and 1-year mortality compared to the STS risk score in patients undergoing TAVR across all surgical risk categories?
Observational (n=3,270)
Does the TVT risk score improve prediction of 30-day and 1-year mortality compared to the STS risk score in patients undergoing TAVR across all surgical risk categories?
Effect estimate: AUC 0.68 (TVT) vs 0.64 (STS) for 30-day mortality
Both the TVT and STS risk scores demonstrate poor discrimination for predicting 30-day and 1-year mortality in patients undergoing TAVR, highlighting the need for an updated, more accurate risk prediction model.
Poor discrimination by both scores cautions TAVR risk stratification; supports development of improved prediction models.
Background: The Society of Thoracic Surgeons (STS) score has been used to risk stratify patients undergoing transcatheter aortic valve replacement (TAVR). The Transcatheter Valve Therapy (TVT) score was developed to predict in-hospital mortality in high/prohibitive-risk patients. Its performance in low and intermediate-risk patients is unknown. We sought to compare TVT and STS scores' ability to predict clinical outcomes in all-surgical-risk patients undergoing TAVR. Methods: Consecutive patients undergoing TAVR from 2012-2020 within a large health care system were retrospectively reviewed and stratified by STS risk score. Predictive abilities of TVT and STS scores were compared using observed-to-expected mortality ratios (O:E) and area under the receiver operating characteristics curves (AUCs) for 30-day and 1-year mortality. Results: We assessed a total of 3270 patients (mean age 79 ± 9 years, 45% female), including 191 (5.8%) low-risk, 1093 (33.4%) intermediate-risk, 1584 (48.4%) high-risk, and 402 (5.8%) inoperable. Mean TVT and STS scores were 3.5% ± 2.0% and 6.1% ± 4.3%, respectively. Observed 30-day and 1-year mortality were 2.8% (92/3270; O:E TVT 0.8 ± 0.16 vs STS 0.46 ± 0.09), and 13.2% (432/3270), respectively. In the all-comers population, both TVT and STS risk scores showed poor prediction of 30-day (AUC: TVT 0.68 [0.62-0.74] vs STS 0.64 [0.58-0.70]), and 1-year (AUC: TVT 0.65 [0.62-0.58] vs STS 0.65 [0.62-0.58]) mortality. After stratifying by surgical risk, discrimination of the TVT and STS scores remained poor in all categories at 30 days and 1 year. Conclusions: An updated TAVR risk score with improved predictive ability across all-surgical-risk categories should be developed based on a larger national registry.
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Al‐Azizi et al. (2023) conducted an observational in Transcatheter aortic valve replacement (TAVR) (n=3,270). TVT score vs. STS score was evaluated on 30-day and 1-year mortality (AUC 0.68 (TVT) vs 0.64 (STS) for 30-day mortality). Both the TVT and STS risk scores showed poor discrimination for predicting 30-day (AUC 0.68 vs 0.64) and 1-year mortality among all-surgical-risk patients undergoing TAVR.
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