Updating the FRANCE-2 and ACC-TAVI early-mortality prediction models using Netherlands Heart Registration data yielded internal validation AU-ROCs of 0.63 for both models.
Observational (n=6,177)
Yes
Updating the ACC-TAVI and FRANCE-2 early-mortality prediction models using recent registry data improves their predictive performance for TAVI patients, with ACC-TAVI showing better temporal stability.
Effect estimate: AU-ROC 0.63 (95% CI 0.62-0.66)
BACKGROUND: The predictive performance of the models FRANCE-2 and ACC-TAVI for early-mortality after Transcatheter Aortic Valve Implantation (TAVI) can decline over time and can be enhanced by updating them on new populations. We aim to update and internally and temporally validate these models using a recent TAVI-cohort from the Netherlands Heart Registration (NHR). METHODS: We used data of TAVI-patients treated in 2013-2017. For each original-model, the best update-method (model-intercept, model-recalibration, or model-revision) was selected by a closed-testing procedure. We internally validated both updated models with 1000 bootstrap samples. We also updated the models on the 2013-2016 dataset and temporally validated them on the 2017-dataset. Performance measures were the Area-Under ROC-curve (AU-ROC), Brier-score, and calibration graphs. RESULTS: We included 6177 TAVI-patients, with 4.5% observed early-mortality. The selected update-method for FRANCE-2 was model-intercept-update. Internal validation showed an AU-ROC of 0.63 (95%CI 0.62-0.66) and Brier-score of 0.04 (0.04-0.05). Calibration graphs show that it overestimates early-mortality. In temporal-validation, the AU-ROC was 0.61 (0.53-0.67).The selected update-method for ACC-TAVI was model-revision. In internal-validation, the AU-ROC was 0.63 (0.63-0.66) and Brier-score was 0.04 (0.04-0.05). The updated ACC-TAVI calibrates well up to a probability of 20%, and subsequently underestimates early-mortality. In temporal-validation the AU-ROC was 0.65 (0.58-0.72). CONCLUSION: Internal-validation of the updated models FRANCE-2 and ACC-TAVI with data from the NHR demonstrated improved performance, which was better than in external-validation studies and comparable to the original studies. In temporal-validation, ACC-TAVI outperformed FRANCE-2 because it suffered less from changes over time.
Al‐Farra et al. (Sat,) conducted a observational in Transcatheter Aortic Valve Implantation (TAVI) (n=6,177). Updated FRANCE-2 and ACC-TAVI early-mortality prediction models was evaluated on Early-mortality prediction performance (AU-ROC) (AU-ROC 0.63, 95% CI 0.62-0.66). Updating the FRANCE-2 and ACC-TAVI early-mortality prediction models using Netherlands Heart Registration data yielded internal validation AU-ROCs of 0.63 for both models.