Valvular Heart Disease
Value of the “TAVI2-SCORe” Versus Surgical Risk Scores for Prediction of One Year Mortality in 511 Patients Who Underwent Transcatheter Aortic Valve Implantation

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A bedside-available transcatheter aortic valve implantation (TAVI)–dedicated prognostic risk score is an unmet clinical need. We aimed to develop such a risk score predicting 1-year mortality post-TAVI and to compare it with the performance of the logistic EuroSCORE (LES) I and LES-II and the Society of Thoracic Surgeons' (STS) score. Baseline variables of 511 consecutive patients who underwent TAVI that were independently associated with 1-year mortality post-TAVI were included in the “TAVI2-SCORe.” Discrimination and calibration abilities of the novel score were assessed and compared with surgical risk scores. One-year mortality was 17.0% (n = 80 of 471). Porcelain thoracic aorta (hazard ratio [HR] 2.56), anemia (HR 2.03), left ventricular dysfunction (HR 1.98), recent myocardial infarction (HR 3.78), male sex (HR 1.81), critical aortic valve stenosis (HR 2.46), old age (HR 1.68), and renal dysfunction (HR 1.76) formed the TAVI2-SCORe (all p <0.05). According to the number of points assigned (1 for each variable and 2 for infarction), patients were stratified into 5 risk categories: 0, 1 (HR 2.6), 2 (HR 3.6), 3 (HR 10.5), and ≥4 (HR 17.6). TAVI2-SCORe showed better discrimination ability (Harrells' C statistic 0.715) compared with LES-I, LES-II, and STS score (0.609, 0.633, and 0.50, respectively). Cumulative 1-year survival rate was 54% versus 88% for patients with TAVI2-SCORE ≥3 versus <3 points, respectively (p <0.001). Contrary to surgical risk scores, there was no significant difference between observed and expected 1-year mortality for all TAVI2-SCORe risk strata (all p >0.05, Hosmer-Lemeshow statistic 0.304), suggesting superior calibration performance. In conclusion, the TAVI2-SCORe is an accurate, simple, and bedside-available score predicting 1-year mortality post-TAVI, outperforming conventional surgical risk scores for this end point.

Section snippets

Methods

Patients with symptomatic severe aortic stenosis (valve area <1.0 cm2; and/or <0.6 cm2/m2; and/or mean gradient ≥40 mm Hg) who underwent TAVI at the Leiden University Medical Center (Leiden, The Netherlands) and Centro Cardiologico Monzino IRCCS (Milan, Italy) between November 2007 and November 2012 were included. All patients were considered to be at high or prohibitive surgical risk, according to the Heart Team decision.

Baseline patient demographic data, cardiovascular risk factors, symptoms,

Results

A total of 511 patients (median age 82 [77 to 86] years, 38% men) were included, of which 207 (41%) were treated in Leiden and 304 (59%) in Milan. A total of 36 patients were excluded because of incomplete data to calculate respective conventional surgical risk scores. Baseline characteristics are listed in Table 1. All patients were at high or prohibitive surgical risk as indicated by mean LES-I, LES-II, and STS score. No patients were lost to follow-up for evaluation of the study end point.

Discussion

This study indicates that TAVI2-SCORe is a simple and novel risk model for accurate prediction of 1-year mortality after TAVI, based on preprocedural baseline patient characteristics. Moreover, the TAVI2-SCORe outperforms discriminatory and calibration abilities of conventional surgical risk scores, including LES-I, LES-II, and STS score.

Cumulative 30-day and 1-year mortality observed in our registry is in line with the respective mortality of 7.4% to 9.7% and 24% reported in the 2 largest

Disclosures

Dr. Debonnaire is supported by a Sadra Medical Research Grant (Boston Scientific, Natick, MA) and holds a European Association of Cardiovascular Imaging Research Grant. Dr. Kamperidis received a European Society of Cardiology Clinical Training Grant. Dr. Katsanos is supported by the Hellenic Society of Cardiology (Athens, Greece). Dr. Joyce holds a European Society Of Cardiology Clinical Training Grant. Dr. Delgado received consulting fees from St. Jude Medical. No specific funding was provided

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