Key result
UK-TAVI model shows strong calibration but moderate discrimination for 30-day mortality with AUC 0.66.
Observational (n=6,339)
Yes
Effect estimate: AUC 0.66 (95% CI 0.61 to 0.71)
The UK-TAVI clinical prediction model provides a well-calibrated tool for benchmarking 30-day mortality across UK TAVI centers, though its moderate discrimination limits its utility for individual patient risk assessment.
Warrants caution before clinical adoption of UK-TAVI model; leaves open refinement of TAVI mortality predictors.
OBJECTIVE: Existing clinical prediction models (CPM) for short-term mortality after transcatheter aortic valve implantation (TAVI) have limited applicability in the UK due to moderate predictive performance and inconsistent recording practices across registries. The aim of this study was to derive a UK-TAVI CPM to predict 30-day mortality risk for benchmarking purposes. METHODS: A two-step modelling strategy was undertaken: first, data from the UK-TAVI Registry between 2009 and 2014 were used to develop a multivariable logistic regression CPM using backwards stepwise regression. Second, model-updating techniques were applied using the 2013-2014 data, thereby leveraging new approaches to include frailty and to ensure the model was reflective of contemporary practice. Internal validation was performed by bootstrapping to estimate in-sample optimism-corrected performance. RESULTS: Between 2009 and 2014, up to 6339 patients were included across 34 centres in the UK-TAVI Registry (mean age, 81.3; 2927 female (46.2%)). The observed 30-day mortality rate was 5.14%. The final UK-TAVI CPM included 15 risk factors, which included two variables associated with frailty. After correction for in-sample optimism, the model was well calibrated, with a calibration intercept of 0.02 (95% CI -0.17 to 0.20) and calibration slope of 0.79 (95% CI 0.55 to 1.03). The area under the receiver operating characteristic curve, after adjustment for in-sample optimism, was 0.66. CONCLUSION: The UK-TAVI CPM demonstrated strong calibration and moderate discrimination in UK-TAVI patients. This model shows potential for benchmarking, but even the inclusion of frailty did not overcome the need for more wide-ranging data and other outcomes might usefully be explored.
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Martin et al. (2017) conducted an observational in Aortic stenosis undergoing transcatheter aortic valve implantation (TAVI) (n=6,339). UK-TAVI clinical prediction model was evaluated on Model discrimination for 30-day mortality (Area Under the Curve) (AUC 0.66, 95% CI 0.61 to 0.71). The UK-TAVI clinical prediction model, incorporating 15 risk factors including frailty, demonstrated strong calibration but moderate discrimination (AUC 0.66) for predicting 30-day mortality.
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