Cardiology Department, AP-HP, Hôpital Bichat Claude Bernard, Paris, France University Paris Diderot, Sorbonne Paris Cité, Paris, France.
University Paris Diderot, Sorbonne Paris Cité, Paris, France Biostatistic Department, AP-HP, Bichat Hospital, Paris, France.
Heart. 2014 Jul;100(13):1016-23. doi: 10.1136/heartjnl-2013-305314. Epub 2014 Apr 16.
Decision making for intervention in symptomatic aortic stenosis should balance the risks of surgery and of transcatheter aortic valve implantation (TAVI). We identified the factors associated with early mortality after TAVI and aimed to develop and validate a simple risk score.
A population of 3833 consecutive patients was randomly split into two cohorts comprising 2552 and 1281 patients, used respectively to develop and validate a scoring system predicting 30-day or in-hospital mortality.
TAVI was performed using the Edwards Sapien prosthesis in 2551 (66.8%) patients and the Medtronic Corevalve in 1270 (33.2%). Approach was transfemoral in 2801 (73.4%) patients, transapical in 678 (17.8%), subclavian in 219 (5.7%) and other in 117 (3.1%). Early mortality was 10.0% (382 patients). A multivariate logistic model identified the following predictive factors of early mortality: age ≥90 years, body mass index <30 Kg/m(2), New York Heart Association class IV, pulmonary hypertension, critical haemodynamic state, ≥2 pulmonary oedemas during the last year, respiratory insufficiency, dialysis and transapical or other (transaortic and transcarotid) approaches. A 21-point predictive score was derived. C-index was 0.67 for the score in the development cohort and 0.59 in the validation cohort. There was a good concordance between predicted and observed 30-day mortality rates in the development and validation cohorts.
Early mortality after TAVI is mainly related to age, the severity of symptoms, comorbidities and transapical approach. A simple score can be used to predict early mortality after TAVI. The moderate discrimination is however a limitation for the accurate identification of high-risk patients.
在有症状的主动脉瓣狭窄患者中进行干预的决策应该平衡手术和经导管主动脉瓣植入术（TAVI）的风险。我们确定了 TAVI 后早期死亡的相关因素，并旨在开发和验证一种简单的风险评分。
将 3833 例连续患者的人群随机分为两个队列，其中 2552 例和 1281 例患者分别用于开发和验证预测 30 天或住院死亡率的评分系统。
2551 例（66.8%）患者使用 Edwards Sapien 假体进行 TAVI，1270 例（33.2%）患者使用 Medtronic Corevalve。2801 例（73.4%）患者采用经股动脉入路，678 例（17.8%）患者采用经心尖入路，219 例（5.7%）患者采用锁骨下入路，117 例（3.1%）患者采用其他入路。早期死亡率为 10.0%（382 例）。多变量逻辑模型确定了早期死亡率的以下预测因素：年龄≥90 岁，体重指数<30 Kg/m(2)，纽约心脏协会（NYHA）心功能分级 IV 级，肺动脉高压，严重血流动力学状态，过去 1 年中≥2 次肺水肿，呼吸功能不全，透析以及经心尖或其他（经主动脉和经颈动脉）途径。由此得出了一个 21 分的预测评分。评分在开发队列中的 C 指数为 0.67，在验证队列中的 C 指数为 0.59。在开发和验证队列中，预测和观察到的 30 天死亡率之间存在良好的一致性。
TAVI 后早期死亡率主要与年龄、症状严重程度、合并症和经心尖途径相关。一种简单的评分可以用于预测 TAVI 后的早期死亡率。但是，适度的区分度是准确识别高危患者的一个局限性。
