Key result
Current TAVI clinical prediction models demonstrated low discrimination (AUC 0.57 to 0.64) and poor risk classification agreement for predicting 30-day mortality in an independent national cohort.
Why the study?
Do existing clinical prediction models accurately predict 30-day mortality in patients undergoing TAVI?
Cohort (n=6,676)
Yes
Do existing clinical prediction models accurately predict 30-day mortality in patients undergoing TAVI?
Effect estimate: AUC 0.57 to 0.64
Current TAVI clinical prediction models demonstrate low discrimination and agreement when applied to an independent national cohort, highlighting the need for recalibration or development of new risk scores.
Existing TAVI models warrant cautious clinical use; challenges their reliability and leaves open need for updated, validated predictors.
BACKGROUND: The performance of emerging transcatheter aortic valve implantation (TAVI) clinical prediction models (CPMs) in national TAVI cohorts distinct from those where they have been derived is unknown. This study aimed to investigate the performance of the German Aortic Valve, FRANCE-2, OBSERVANT and American College of Cardiology (ACC) TAVI CPMs compared with the performance of historic cardiac CPMs such as the EuroSCORE and STS-PROM, in a large national TAVI registry. METHODS: The calibration and discrimination of each CPM were analyzed in 6676 patients from the UK TAVI registry, as a whole cohort and across several subgroups. Strata included gender, diabetes status, access route, and valve type. Furthermore, the amount of agreement in risk classification between each of the considered CPMs was analyzed at an individual patient level. RESULTS: The observed 30-day mortality rate was 5.4%. In the whole cohort, the majority of CPMs over-estimated the risk of 30-day mortality, although the mean ACC score (5.2%) approximately matched the observed mortality rate. The areas under ROC curve were between 0.57 for OBSERVANT and 0.64 for ACC. Risk classification agreement was low across all models, with Fleiss's kappa values between 0.17 and 0.50. CONCLUSIONS: Although the FRANCE-2 and ACC models outperformed all other CPMs, the performance of current TAVI-CPMs was low when applied to an independent cohort of TAVI patients. Hence, TAVI specific CPMs need to be derived outside populations previously used for model derivation, either by adapting existing CPMs or developing new risk scores in large national registries.
No takes yet. Share an insight, caveat, or question.
Martin et al. (2016) conducted a cohort in Transcatheter aortic valve implantation (TAVI) (n=6,676). TAVI clinical prediction models (German Aortic Valve, FRANCE-2, OBSERVANT, ACC) vs. Historic cardiac clinical prediction models (EuroSCORE, STS-PROM) was evaluated on 30-day mortality prediction performance (calibration and discrimination) (AUC 0.57 to 0.64). Current TAVI clinical prediction models demonstrated low discrimination (AUC 0.57 to 0.64) and poor risk classification agreement for predicting 30-day mortality in an independent national cohort.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: