Aims: Surgical risk scores have failed to accurately predict events after TAVI, stressing the need for a dedicated tool incorporating all clinical variables useful to discriminate risk of patients undergoing TAVI. Methods and results: All consecutive patients undergoing TAVI at our institutions were enrolled. The primary endpoint was one year all-cause mortality (as for VARC definition), and secondary endpoint was all-cause death after 30 days. Accuracy of the score was derived, and externally validated. Net classification improvement compared to STS score was appraised. A total of 1064 patients constituted the derivation cohort, and 180 the external validation cohort. 165 patients (15%) died at one year follow up, and previous stroke (OR 1.80; 1.4-3), inverse of renal clearance (OR 8; 6-14) and systolic pulmonary arterial pressure more than 50 mmHg (OR 2.10; 1.5-3) were independently related to all-cause mortality. Area Under the Curve (AUC) of the Survival posT TAVI (STT) for the primary end point was of 0.68 (0.62-0.71). At 30 days, 65 (7%) died, and AUC for them was 0.66: (0.64-0.75). On external validation cohorts, AUC curves of STT were, respectively, 0.66 (0.56-0.7) for 30 days and 0.67 (0.62-0.71) for all-cause mortality at follow-up. Net reclassification improvement (NRI), for 30 days all-cause mortality for STT compared to STS was of 31% (p<0.001), and of 14% (p<0.001) for all-cause mortality at follow up. Conclusions: STT represents an easy and accurate score to define risk of 30 days and of mid-term mortality for patients undergoing TAVI, improving STS score performance.
Survival post transcatheter aortic valve implantation for aortic stenosis: the STT score. derivation and external validation
D'ASCENZO, FABRIZIO;GAITA, Fiorenzo;
2014-01-01
Abstract
Aims: Surgical risk scores have failed to accurately predict events after TAVI, stressing the need for a dedicated tool incorporating all clinical variables useful to discriminate risk of patients undergoing TAVI. Methods and results: All consecutive patients undergoing TAVI at our institutions were enrolled. The primary endpoint was one year all-cause mortality (as for VARC definition), and secondary endpoint was all-cause death after 30 days. Accuracy of the score was derived, and externally validated. Net classification improvement compared to STS score was appraised. A total of 1064 patients constituted the derivation cohort, and 180 the external validation cohort. 165 patients (15%) died at one year follow up, and previous stroke (OR 1.80; 1.4-3), inverse of renal clearance (OR 8; 6-14) and systolic pulmonary arterial pressure more than 50 mmHg (OR 2.10; 1.5-3) were independently related to all-cause mortality. Area Under the Curve (AUC) of the Survival posT TAVI (STT) for the primary end point was of 0.68 (0.62-0.71). At 30 days, 65 (7%) died, and AUC for them was 0.66: (0.64-0.75). On external validation cohorts, AUC curves of STT were, respectively, 0.66 (0.56-0.7) for 30 days and 0.67 (0.62-0.71) for all-cause mortality at follow-up. Net reclassification improvement (NRI), for 30 days all-cause mortality for STT compared to STS was of 31% (p<0.001), and of 14% (p<0.001) for all-cause mortality at follow up. Conclusions: STT represents an easy and accurate score to define risk of 30 days and of mid-term mortality for patients undergoing TAVI, improving STS score performance.
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