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Second-generation risk score for TAVR inadequate to predict mortality
The European System for Cardiac Operative Risk Evaluation II performed better than other tests for predicting mortality after transcatheter aortic valve replacement, but receiver operating characteristics showed that all risk scores poorly predicted both 30-day mortality and combined safety endpoints.
Researchers of the study appearing in Catheterization and Cardiovascular Interventions compared risk scores for TAVR using the European System for Cardiac Operative Risk Evaluation II (ESII), the logistic European System for Cardiac Operative Risk Evaluation Score (LES) and Society of Thoracic Surgeons Predicted Risk of Mortality score. They enrolled 453 consecutive patients (mean age, 83.1 ± 6.4 years) who had severe aortic stenosis and underwent TAVR with either the Sapien valve (Edwards Lifesciences) or the CoreValve (Medtronic) from October 2006 to November 2011.
The Sapien valve was used in 382 patients (84.3%). Researchers performed TAVR using the transfemoral approach (TF) in 55% of patients, the transapical approach (TA) in 25.2%, the transaortic approach (TAo) in 17.8%, and the trans-subclavian approach (SC) in 2%.
Thirty-day mortality was 12.6% (11.2% for TF; 18.4% for TA; 7.4% for Tao; and 22.2% for SC). The mean value of LES was 22.4 ± 12.1; 8.1 ± 6 for STS; and 8.1 ± 5.2 for ESII.
ESII was inadequately calibrated for 30-day mortality compared with other risk scores as shown by the Hosmer-Lemeshow test, which indicates a more calibrated score by lower statistics and higher P values (ESII, P=.09; LES, P=.84; STS, P=.34). ESII better predicted 30-day mortality, albeit poorly, compared with LES and STS (area under the receiver operating characteristic curve: ESII, 0.68; LES, 0.65; and STS, 0.60).
“The improvement factors enhancing the prediction accuracy of ESII lie not only in risk parameters such as diabetes and renal dysfunctions, but also in the assessment of morbidity, which introduced partial quantification of frailty into the model,” researchers wrote.
Disclosure: Watanabe reports no relevant financial disclosures.