Original Article
Meta-analysis on the Performance of the EuroSCORE II and the Society of Thoracic Surgeons Scores in Patients Undergoing Aortic Valve Replacement

https://doi.org/10.1053/j.jvca.2014.03.014Get rights and content

Objective

To evaluate the performance of the EuroSCORE II (ESII) and the Society of Thoracic Surgeons (STS) scores in surgical (SAVR) or transcatheter aortic valve replacement (TAVR).

Design

Systematic review of the literature and meta-analysis.

Setting

University hospitals.

Participants

Studies reporting data on the performance of ESII and STS scores in patients undergoing SAVR or TAVR.

Interventions

SAVR or TAVR.

Measurements and Main Results

Ten studies validated these scores in 13,856 patients who underwent either TAVR or SAVR. Operative mortality was 5.9% (SAVR 3.1%; TAVR 9.6%). ESII-expected mortality was 5.1% (O/E ratio: 1.15, SAVR, O/E ratio 0.94; TAVR, O/E ratio 1.23) and STS-expected mortality was 6.3% (O/E ratio: 0.94, SAVR, O/E ratio 0.84; TAVR, O/E ratio 1.13). The area under the ROC curve for ESII was 0.70 and for STS was 0.70 (SAVR patients: 0.73 for ESII and 0.75 for STS; TAVR patients; 0.66 for ESII and 0.63 for STS). The difference between observed/expected mortality was not significant for ESII (Peto’s OR 0.99, p = 0.88) and was significant for STS (Peto’s OR 0.86, p = 0.008). ESII (Peto’s OR 1.35, p<0.00001) and STS (Peto’s OR 1.23, p<0.00001) significantly underestimated the mortality risk in TAVR patients. The STS (Peto’s OR 0.74, p<0.0001) and, to a lesser extent, the ESII (Peto’s OR 0.86, p = 0.0.04) overestimated the mortality risk in SAVR patients.

Conclusions

The ESII and STS scores have good O/E ratios for either TAVR or SAVR patients, but both scores significantly underpredicted the risk of TAVR patients. ESII seemed to be accurate in predicting the risk of SAVR patients.

Section snippets

Methods

A literature review was performed through PubMed, Scopus, Science Direct and Google for any study published since 2011 and evaluating the performance of the ESII score and the STS score in the same population of patients undergoing SAVR or TAVR. The word employed in the search was “EuroSCORE II”. Reference lists of obtained articles were searched as well. This study was not financially supported.

Results

A literature search was performed on March 16, 2014 and yielded 138 articles of which 107, 8, 9, 10, 11, 12, 13, 14, 15, 16 reported on data of interest and fulfilled the inclusion criteria of the present study (Fig 1). No prospective study was available for this analysis.

Table 1 summarizes the main characteristics of these studies. These studies included 13,856 patients with 577 operative deaths. SVAR was performed in 11,791 patients and TAVR in 2,065 patients. The pooled operative mortality

Discussion

This pooled analysis showed that current O/E mortality ratios estimated by either the ESII score or the STS score approached 1.0 in patients undergoing aortic valve replacement. This is a remarkable improvement particularly for the ESII score, as the logistic EuroSCORE was shown to significantly and markedly overpredict the operative risk.17 In fact, the O/E mortality ratio estimated by the logistic EuroSCORE in patients undergoing aortic valve surgery with or without coronary surgery was shown

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