Thorac Cardiovasc Surg 2017; 65(S 01): S1-S110
DOI: 10.1055/s-0037-1598905
Oral Presentations
Tuesday, February 14th, 2017
DGTHG: Catheter-based Heart Valve Techniques - TAVI: Risk Evaluation
Georg Thieme Verlag KG Stuttgart · New York

TAVR Risk Scoring Using Established versus New Scoring Systems: Role of the New STS/ACC Model

M. Arsalan
1   Kerckhoff Klinik, Cardiac Surgery, Bad Nauheim, Germany
,
M. Weferling
2   Kerckhoff Klinik, Cardiology, Bad Nauheim, Germany
,
F. Hecker
1   Kerckhoff Klinik, Cardiac Surgery, Bad Nauheim, Germany
,
G. Filardo
3   Baylor Scott and White Health, Department of Epidemiology, Dallas, United States
,
W.K. Kim
1   Kerckhoff Klinik, Cardiac Surgery, Bad Nauheim, Germany
,
B. Pollock
3   Baylor Scott and White Health, Department of Epidemiology, Dallas, United States
,
A. Van Linden
1   Kerckhoff Klinik, Cardiac Surgery, Bad Nauheim, Germany
,
A. Arsalan-Werner
1   Kerckhoff Klinik, Cardiac Surgery, Bad Nauheim, Germany
,
M. Renker
2   Kerckhoff Klinik, Cardiology, Bad Nauheim, Germany
,
M. Doss
1   Kerckhoff Klinik, Cardiac Surgery, Bad Nauheim, Germany
,
S. Kalbas
2   Kerckhoff Klinik, Cardiology, Bad Nauheim, Germany
,
C. Hamm
2   Kerckhoff Klinik, Cardiology, Bad Nauheim, Germany
,
C. Liebetrau
2   Kerckhoff Klinik, Cardiology, Bad Nauheim, Germany
,
M. Mack
4   The Heart Hospital Baylor Plano, Plano, United States
,
T. Walther
1   Kerckhoff Klinik, Cardiac Surgery, Bad Nauheim, Germany
› Author Affiliations
Further Information

Publication History

Publication Date:
03 February 2017 (online)

 
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    Objectives: Despite more than ten years of clinical experience with transcatheter aortic valve replacement (TAVR) a reliable risk score model is not yet available. Only recently a TAVR-specific risk score model has been developed: the STS/ACC TAVR in-hospital mortality risk score. This study validates the STS/ACC TAVR score for predicting in-hospital mortality and compares its ability to predict 30-day mortality with that of four other established risk models (EuroScore I, EuroScore II, STS-PROM, and German AKL) at a tertiary care center in Germany.

    Methods: The study cohort included 946 consecutive patients who underwent TAVR between 2013 and 2015. Each of the five scores was fit as a continuous linear variable into a logistic regression model estimating 30-day mortality. The STS/ACC TAVR score was additionally analyzed for in-hospital-mortality. The same analysis was repeated by modeling each score using restricted cubic splines with three knots. C statistics and likelihood ratio (LR) test p-values were estimated for each of the ten models to describe the model fit.

    Results: In-hospital mortality was 4.9%. The ability of the STS/ACC score to predict in-hospital mortality was similar to the reported STS/ACC TVT Registry data (this studies C statistic 0.65 versus STS/ACC TVT Registry 0.66). The 30-day mortality was 6.3%. The STS-PROM score (C statistic=0.68;LR p < 0.0001) and the new STS/ACC TAVR score (C statistic = 0.68; LR p < 0.0001) were superior to the other scores (EuroScore I [C statistic = 0.55; LR p = 0.02], EuroScore II [C statistic = 0.58; LR p = 0.02], German AKL [C statistic=0.62;LR p < 0.01]) for prediction of 30-day mortality.

    Conclusion: These data show the superiority of the STS-PROM and STS/ACC TAVR scores compared with other existing risk calculation models in predicting 30-day mortality after TAVR in a German all-comers population. The STS/ACC TAVR score, however, is easier to calculate (12 vs. 28 variables) and thus may gain wider acceptance and be accompanied by improved inter-observer reliability.


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    No conflict of interest has been declared by the author(s).

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