现有的手术风险评分预测经导管主动脉瓣置换术后结局的准确性不足。
Inaccuracy of available surgical risk scores to predict outcomes after transcatheter aortic valve replacement.
机构信息
aDivision of Cardiology, Department of Internal Medicine, Città Della Salute e Della Scienza bDivision of Cardiac-Surgery, San Giovanni Battista Molinette, University of Turin, Turin cDivision of Cardiology, Azienda Ferrarotto Hospital, University of Catania, Catania dDepartment of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Rome eDivision of Cardiology, Istituto Clinico Humanitas, Milan fDivision of Cardiology, Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, Padova, Italy.
出版信息
J Cardiovasc Med (Hagerstown). 2013 Dec;14(12):894-8. doi: 10.2459/JCM.0b013e3283638e26.
INTRODUCTION
Despite encouraging short-term and mid-term results, transcatheter aortic valve implantation (TAVI) interventions are still burdened from high rates of adverse events, stressing the need for accurate predictive risk instruments. We compared available surgical risk scores to describe unfavorable outcomes after TAVI.
METHODS
The Age, Creatinine, and Ejection fraction (ACEF) score, the logistic Euroscore, and the Society of Thoracic Surgeons Mortality score (STS) were appraised for their independent power of prediction and for their accuracy (C-index) to predict 30-day and medium-term mortality, according to the Valve Academic Research Consortium.
RESULTS
Nine hundred and sixty-two patients were included. All the scores demonstrated a moderate positive correlation. The closest correlation was observed between the STS score and Euroscore. After logistic regression analysis, STS score and Logistic Euroscore provided independent prediction for short-term all-cause mortality [P = 0.02, odds ratio (OR) 1.1; 95% confidence interval (CI) 1.06-1.31 and P = 0.027, OR 1.03; 95% CI 1.01-1.405]. For in-hospital complications, only STS score performed significantly (P = 0.005, OR 1.05; 95% CI 1.01-1.06). ACEF, Euroscore, and STS score showed low accuracy for 30-day all-cause mortality (area under the curve 0.6, 0.44-0.75; vs. 0.53, 0.42-0.61; vs. 0.62, 0.52-0.71, respectively), whereas STS score performed better for in-hospital complications (0.59, 0.55-0.64). Moreover, after Cox-multivariate adjustments, only ACEF score was near to significance to predict all-cause mortality at mid-term (OR 1.7; 0.8-2.9; P = 0.058), showing the highest accuracy (0.63, 0.55-0.71).
CONCLUSION
In TAVI patients, ACEF score, STS score and Logistic Euroscore provided only a moderate correlation and a low accuracy both for 30-day and medium-term outcomes. Dedicated scores are needed to properly tailor time and kind of approach.
简介
尽管经导管主动脉瓣植入术（TAVI）的短期和中期结果令人鼓舞，但该手术仍存在较高的不良事件发生率，这凸显了对准确预测风险工具的需求。我们比较了现有的手术风险评分，以描述 TAVI 后的不良预后。
方法
评估年龄、肌酐和射血分数（ACEF）评分、逻辑欧洲评分和胸外科医生协会死亡率评分（STS）的独立预测能力及其准确性（C 指数），以根据 Valve Academic Research Consortium 预测 30 天和中期死亡率。
结果
共纳入 962 例患者。所有评分均显示出中度正相关。STS 评分与 Euroscore 之间的相关性最密切。逻辑回归分析后，STS 评分和 Logistic Euroscore 对短期全因死亡率具有独立预测作用[P=0.02，优势比（OR）1.1；95%置信区间（CI）1.06-1.31 和 P=0.027，OR 1.03；95%CI 1.01-1.405]。对于院内并发症，只有 STS 评分具有显著意义（P=0.005，OR 1.05；95%CI 1.01-1.06）。ACEF、Euroscore 和 STS 评分对 30 天全因死亡率的准确性较低（曲线下面积 0.6、0.44-0.75；0.53、0.42-0.61；0.62、0.52-0.71，分别），而 STS 评分对院内并发症的预测效果更好（0.59、0.55-0.64）。此外，Cox 多变量调整后，只有 ACEF 评分接近显著性，可预测中期全因死亡率（OR 1.7；0.8-2.9；P=0.058），其准确性最高（0.63、0.55-0.71）。
结论
在 TAVI 患者中，ACEF 评分、STS 评分和 Logistic Euroscore 仅对 30 天和中期结果具有中度相关性和较低的准确性。需要专门的评分来适当调整时间和方法。
Zotero 插件