Division of Cardiovascular Diseases and Section of Biostatistics, Mayo Clinic, Rochester, Minnesota 55905, USA.
Ann Thorac Surg. 2010 Dec;90(6):1876-83. doi: 10.1016/j.athoracsur.2010.07.070.
The Society of Thoracic Surgeons (STS) score aims at predicting operative mortality in cardiac surgery. The value of this score in predicting short- and long-term survival with medical or surgical management in patients with asymptomatic severe aortic stenosis (AS) is unknown.
In a cohort of 694 patients (aged 71 ± 11 years) with isolated, asymptomatic severe AS (velocity ≥4 m/s), STS score was calculated at baseline and its link to survival analyzed. Patients were stratified by STS score less than 4%, 4% to 6.5%, and 6.5% or greater.
The STS score showed no association with operative mortality within 1 year of diagnosis or any time (1%, 2.9%, and 6.1%, respectively, by strata; p = 0.08) and a weak association with 1-year survival (p = 0.04). Conversely, long-term survival (10-year) was strongly predicted by STS score strata (78%, 47%, and 16%, respectively; p < 0.0001). In multivariate analysis, STS score independently predicted mortality (hazard ratio/1%, 1.15 [1.12 to 1.18], p < 0.0001) or cardiac death (1.21 [1.17 to 1.25], p < 0.0001). Aortic valve replacement within 1 year of diagnosis markedly improved survival (adjusted hazard ratio, 0.58, p < 0.001). However, benefit of early surgery varied according to strata, with no overt benefit with low score (p = 0.83), whereas early surgery considerably improved survival in the intermediate strata (p < 0.001).
For patients with asymptomatic severe AS, STS score is a powerful tool for predicting long-term outcome and for selecting patients (particularly those at intermediate risk) who benefit markedly from early surgery. Hence, risk-scoring using STS score should be routinely performed in patients with AS to support the clinical decision-making process.
胸外科医师学会（STS）评分旨在预测心脏手术的手术死亡率。该评分在预测无症状重度主动脉瓣狭窄（AS）患者接受药物或手术治疗的短期和长期生存率方面的价值尚不清楚。
在一个 694 例孤立性、无症状重度 AS（速度≥4m/s）患者的队列中，在基线时计算 STS 评分，并分析其与生存的关系。根据 STS 评分<4%、4%~6.5%和≥6.5%将患者分层。
STS 评分与诊断后 1 年内或任何时间的手术死亡率均无关联（各分层分别为 1%、2.9%和 6.1%；p=0.08），与 1 年生存率呈弱相关（p=0.04）。相反，STS 评分分层强烈预测长期生存（10 年）（分别为 78%、47%和 16%；p<0.0001）。多变量分析显示，STS 评分独立预测死亡率（每 1%的危险比为 1.15[1.12 至 1.18]，p<0.0001）或心脏性死亡（1.21[1.17 至 1.25]，p<0.0001）。诊断后 1 年内进行主动脉瓣置换术显著改善了生存率（校正后的危险比为 0.58，p<0.001）。然而，早期手术的获益因分层而异，低评分组（p=0.83）无明显获益，而中危分层患者早期手术显著改善了生存率（p<0.001）。
对于无症状重度 AS 患者，STS 评分是预测长期预后和选择明显受益于早期手术的患者（尤其是中危患者）的有力工具。因此，应常规对 AS 患者进行 STS 评分风险评估，以支持临床决策过程。
