Johansson Malin, Nozohoor Shahab, Zindovic Igor, Nilsson Johan, Kimblad Per Ola, Sjögren Johan
J Heart Valve Dis. 2014 Sep;23(5):567-74.
The logistic EuroSCORE and STS score have been used for the selection of suitable TAVI patients, but their predictive ability is unsatisfactory. The study aim was to evaluate the performance of the EuroSCORE II in predicting 30-day mortality after TAVI in comparison to the logistic EuroSCORE and STS scoring systems.
Between January 2008 and April 2013, a total of 123 consecutive patients underwent TAVI (transapical, n = 85; transfemoral, n = 38) at the authors' institution. Calibration and discriminatory ability was evaluated for three risk scores models (logistic EuroSCORE, STS score, and EuroSCORE II), and compared for the prediction of 30-day mortality using the Hosmer-Lemeshow test for goodness-of-fit and receiver operating characteristics curve analysis.
The overall 30-day mortality was 4.1% (5/123). Predicted mortality was 25.0 ± 15.7% by logistic EuroSCORE, 7.3 ± 6.9% by STS score, and 7.8 ± 8.7% by EuroSCORE II. The observed/expected mortality ratio was 0.16 for logistic EuroSCORE, 0.56 for STS score, and 0.52 for EuroSCORE II. The area under the curve was 0.69 (95% CI 0.54-0.84) for the logistic EuroSCORE, 0.60 (95% CI 0.38-0.82) for the STS score, and 0.66 (95% CI 0.46-0.86) for the EuroSCORE II.
In the present study, the EuroSCORE II was found to predict 30-day mortality more accurately for the TAVI cohort than did the more established logistic EuroSCORE, and also to compare (at present) on a par with the STS score. However, there were no differences in discriminatory power between the models. It is believed that, in the absence of a more TAVI-oriented risk stratification system, the EuroSCORE II may be a valuable adjunct in the clinical setting.
逻辑欧洲心脏手术风险评估系统（logistic EuroSCORE）和胸外科医师协会（STS）评分系统已用于选择合适的经导管主动脉瓣植入术（TAVI）患者，但其预测能力并不理想。本研究旨在评估欧洲心脏手术风险评估系统II（EuroSCORE II）与逻辑欧洲心脏手术风险评估系统和STS评分系统相比，在预测TAVI术后30天死亡率方面的性能。
2008年1月至2013年4月期间，共有123例连续患者在作者所在机构接受了TAVI（经心尖入路，n = 85；经股动脉入路，n = 38）。对三种风险评分模型（逻辑欧洲心脏手术风险评估系统、STS评分系统和EuroSCORE II）的校准和鉴别能力进行了评估，并使用Hosmer-Lemeshow拟合优度检验和受试者工作特征曲线分析对30天死亡率的预测进行了比较。
总体30天死亡率为4.1%（5/123）。逻辑欧洲心脏手术风险评估系统预测的死亡率为25.0±15.7%，STS评分系统为7.3±6.9%，EuroSCORE II为7.8±8.7%。逻辑欧洲心脏手术风险评估系统的观察/预期死亡率比值为0.16，STS评分系统为0.56，EuroSCORE II为0.52。逻辑欧洲心脏手术风险评估系统的曲线下面积为0.69（95%CI 0.54 - 0.84），STS评分系统为0.60（95%CI 0.38 - 0.82），EuroSCORE II为0.66（95%CI 0.46 - 0.86）。
在本研究中，发现EuroSCORE II比更成熟的逻辑欧洲心脏手术风险评估系统能更准确地预测TAVI队列的30天死亡率，并且（目前）与STS评分系统相当。然而，各模型之间的鉴别能力没有差异。据信，在缺乏更针对TAVI的风险分层系统的情况下，EuroSCORE II在临床环境中可能是一种有价值的辅助工具。
