Beohar Nirat, Whisenant Brian, Kirtane Ajay J, Leon Martin B, Tuzcu E Murat, Makkar Raj, Svensson Lars G, Miller D Craig, Smith Craig R, Pichard Augusto D, Herrmann Howard C, Thourani Vinod H, Szeto Wilson Y, Lim Scott, Fischbein Michael, Fearon William F, O'Neill William, Xu Ke, Dewey Todd, Mack Michael
Cardiac Catheterization Laboratory, Columbia University Division of Cardiology, Mount Sinai Medical Center, Miami Beach, Fla.
Intermountain Medical Center, Salt Lake City, Utah.
J Thorac Cardiovasc Surg. 2014 Dec;148(6):2830-7.e1. doi: 10.1016/j.jtcvs.2014.04.006. Epub 2014 Apr 13.
The logistic European System for Cardiac Operative Risk Evaluation (LES) score and the Society of Thoracic Surgeons (STS) score are validated to predict 30-day outcomes following surgical aortic valve replacement (SAVR) with or without coronary artery bypass grafting. Their performance when applied to patients undergoing transcatheter aortic valve replacement (TAVR) is controversial.
We compared predicted and observed 30-day/in-hospital and 1-year mortality of patients undergoing TAVR in the first Placement of Aortic Transcatheter Valves trial and continued access registry (N = 2466). The performance of the LES and STS scores (prospectively calculated) was evaluated using standard assessments of discrimination and calibration. Performance of STS and LES scores among 307 patients undergoing SAVR from the high-risk cohort of the randomized trial were also examined.
In patients undergoing TAVR, the observed 30-day/in-hospital mortality was 6.5%, whereas the predicted 30-day mortality was higher by both STS score (11.4% ± 3.9%) and LES score (26.6% ± 16.2%). The discrimination for both scores was poor for 30-day/in-hospital and 1-year mortality. Calibration was better for STS score than for LES at 1 year but poor for both at 30 days among TAVR cohort. These results were consistent among the subgroups of patients undergoing transfemoral and transapical access; however, the STS score had better performance among the high-risk patients who underwent SAVR at 30 days but not 1 year.
The STS and LES surgical risk scores overestimated 30-day/in-hospital mortality and were poor discriminators of post-TAVR mortality, but the calibration of the STS score was better in these high-risk patients. These data highlight the need for TAVR-specific risk models to optimize patient selection.
逻辑斯蒂欧洲心脏手术风险评估系统（LES）评分和胸外科医师协会（STS）评分已得到验证，可用于预测有或无冠状动脉旁路移植术的外科主动脉瓣置换术（SAVR）后30天的结局。将其应用于经导管主动脉瓣置换术（TAVR）患者时，其性能存在争议。
我们在首次主动脉经导管瓣膜置入试验和持续接入登记研究（N = 2466）中，比较了TAVR患者预测的和观察到的30天/住院期间及1年死亡率。使用鉴别和校准的标准评估方法，对LES和STS评分（前瞻性计算）的性能进行了评估。还检查了随机试验高危队列中307例接受SAVR患者的STS和LES评分性能。
在接受TAVR的患者中，观察到的30天/住院期间死亡率为6.5%，而根据STS评分（11.4%±3.9%）和LES评分（26.6%±16.2%）预测的30天死亡率更高。对于30天/住院期间及1年死亡率，这两种评分的鉴别能力均较差。在TAVR队列中，1年时STS评分的校准优于LES评分，但30天时两者的校准均较差。这些结果在经股动脉和经心尖接入的患者亚组中是一致的；然而，STS评分在30天时接受SAVR的高危患者中表现较好，但在1年时并非如此。
STS和LES手术风险评分高估了30天/住院期间死亡率，对TAVR后死亡率的鉴别能力较差，但在这些高危患者中，STS评分的校准更好。这些数据凸显了需要有针对TAVR的风险模型来优化患者选择。
