Key result
Established surgical risk scores were inaccurate in predicting 30-day mortality after transcatheter aortic valve implantation, with the logistic EuroSCORE I yielding an AUC of 0.58.
Why the study?
Do traditional surgical risk scores accurately predict 30-day mortality in patients undergoing transcatheter aortic valve implantation?
Observational (n=418)
Yes
Do traditional surgical risk scores accurately predict 30-day mortality in patients undergoing transcatheter aortic valve implantation?
Effect estimate: AUC 0.58 (95% CI 0.49-0.68)
p-value: p=0.09
Traditional surgical risk scores, including the STS score and EuroSCORE, demonstrate poor discrimination for predicting 30-day mortality after TAVI, highlighting the need for TAVI-specific risk models.
Surgical scores should not guide TAVI decisions; leaves open need for dedicated TAVI mortality models.
BACKGROUND: Predicting mortality in patients undergoing transcatheter aortic valve implantation (TAVI) remains a challenge. OBJECTIVES: To evaluate the performance of 5 risk scores for cardiac surgery in predicting the 30-day mortality among patients of the Brazilian Registry of TAVI. METHODS: The 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)]. RESULTS: The 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). CONCLUSIONS: In this real world Brazilian registry, the surgical risk scores were inaccurate in predicting mortality after TAVI. Risk models specifically developed for TAVI are required.
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Silva et al. (2015) conducted an observational in Severe aortic stenosis (n=418). Surgical risk scores (logistic EuroSCORE I, EuroSCORE II, STS score, Ambler score, Guaragna score) vs. Observed mortality was evaluated on Discrimination of 30-day mortality (Area Under the ROC Curve) (AUC 0.58, 95% CI 0.49-0.68, p=0.09). Established surgical risk scores were inaccurate in predicting 30-day mortality after transcatheter aortic valve implantation, with the logistic EuroSCORE I yielding an AUC of 0.58.
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