Key result
In patients undergoing transapical aortic valve implantation, the new EuroSCORE II was a poorer predictor of 30-day mortality (AUC 0.50) than the STS score (AUC 0.64).
Why the study?
Does the EuroSCORE II better predict 30-day and in-hospital mortality compared to the logistic EuroSCORE and STS score in high-risk patients undergoing transapical aortic valve implantation?
Cohort (n=360)
Does the EuroSCORE II better predict 30-day and in-hospital mortality compared to the logistic EuroSCORE and STS score in high-risk patients undergoing transapical aortic valve implantation?
Effect estimate: AUC 0.50 for EuroSCORE II vs 0.64 for STS score
The new EuroSCORE II is a poorer predictor of 30-day and in-hospital mortality than the STS score in high-risk patients undergoing transapical aortic valve implantation.
EuroSCORE II should not yet inform risk assessment in transapical TAVI; leaves open validation of STS and procedure-specific models.
OBJECTIVES: Conventional surgical risk scores are used to identify suitable candidates for transapical aortic valve implantation (TA-AVI) at present. However, these scores do not consider multiple high-risk conditions, including porcelain aorta, mediastinal irradiation or frailty. The aim of this study was to compare the predictive ability of the new EuroSCORE II with the surgical risk scores currently in use. METHODS: From February 2006 to May 2011, 360 consecutive high-risk patients, age 81.6 ± 6.4 years, 64.4% female, were included using the Edwards SAPIEN™ prosthesis. The prognostic value of the EuroSCORE II was evaluated and compared with the logistic EuroSCORE and STS mortality score by receiver operating characteristics (ROC) curve analysis. In addition, a Spearman correlation analysis was performed, and a stepwise multivariate Cox regression used to identify the independent risk factors of mortality. RESULTS: The STS score and EuroSCORE II (r = 0.504, P < 0.001) showed a good correlation, while a strong correlation was found between the logistic EuroSCORE and EuroSCORE II (r = 0.717, P < 0.001). Thirty-day and in-hospital mortality rates were 10.6% (38 of 360) and 11.4% (41 of 360), respectively. In-hospital mortality rate was estimated by the logistic EuroSCORE: 30.0 ± 15.7%, the STS score: 11.7 ± 7.8% and the EuroSCORE II: 6.7 ± 5.1%. The prognostic values of the STS score, logistic EuroSCORE and the recent EuroSCORE II systems were analysed by ROC curve analysis for the prediction of 30-day (area under the curve, AUC: 0.64 vs 0.55 vs 0.50) and in-hospital mortality (AUC: 0.65 vs 0.54 vs 0.49). Multivariate regression analysis revealed length of preoperative hospital stay >5 days, body weight <65 kg, preoperative aortic annular diameter ≤ 20 mm, vital capacity <70% and concomitant mitral regurgitation >1+ as independent risk factors. CONCLUSION: In patients undergoing TA-AVI, the new EuroSCORE II correlates strongly with the logistic EuroSCORE, but is a poorer predictor of 30-day and in-hospital mortality than the STS score. A true transcatheter aortic valve implantation risk score would be desirable beyond the established scores.
No takes yet. Share an insight, caveat, or question.
Haensig et al. (2013) conducted a cohort in High-risk patients undergoing transapical aortic valve implantation (TA-AVI) (n=360). EuroSCORE II vs. STS score and logistic EuroSCORE was evaluated on Prediction of 30-day mortality (AUC) (AUC 0.50 for EuroSCORE II vs 0.64 for STS score). In patients undergoing transapical aortic valve implantation, the new EuroSCORE II was a poorer predictor of 30-day mortality (AUC 0.50) than the STS score (AUC 0.64).
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: