Wang Tom Kai Ming, Wang Michael Tzu Min, Gamble Greg D, Webster Mark, Ruygrok Peter N
Green Lane Cardiovascular Service, Auckland City Hospital, Auckland, New Zealand; Department of Medicine, University of Auckland, Auckland, New Zealand.
Department of Medicine, University of Auckland, Auckland, New Zealand.
Int J Cardiol. 2017 Jun 1;236:350-355. doi: 10.1016/j.ijcard.2016.12.188. Epub 2017 Jan 16.
Transcatheter aortic valve implantation (TAVI) is considered for severe aortic valve disease at high and now intermediate risk for surgical aortic valve replacement. Risk stratification plays a critical role decision-making for intervention and modality. We compared the prognostic utility of surgical risk scores for TAVI in this meta-analysis.
MEDLINE, Embase, Cochrane and Web of Science databases from 1 January 1980 to 31 December 2015 were searched. Studies were systematically reviewed for inclusion, and data extracted for pooled analyses.
Amongst 1688 articles searched, 47 full-text articles were screened and 24 studies (12,346 TAVI cases) included for analyses. Pooled c-statistics (95% confidence interval) for operative mortality were EuroSCORE 0.62 (0.57-0.67), EuroSCORE II 0.62 (0.59-0.66), STS Score 0.62 (0.59-0.65). Pooled calibration odds ratios (95%CI) were EuroSCORE 0.31 (0.25-0.38), EuroSCORE II 1.26 (1.06-1.51), STS 0.95 (0.72-1.27). C-statistics (95%CI) for 1-year mortality were EuroSCORE 0.62 (0.57-0.67), EuroSCORE II 0.66 (0.61-0.71) and STS Score 0.58 (0.53-0.64).
Surgical risk scores at most modestly discriminated operative and 1-year mortality. The EuroSCORE grossly over-estimated operative mortality while the EuroSCORE II and STS Scores fitted better to TAVI outcomes with their own limitations. There is a need for the development and validation of TAVI-specific risk models.
经导管主动脉瓣植入术（TAVI）适用于外科主动脉瓣置换术高风险及现在的中风险的严重主动脉瓣疾病。风险分层在干预和治疗方式的决策中起着关键作用。在这项荟萃分析中，我们比较了TAVI手术风险评分的预后效用。
检索了1980年1月1日至2015年12月31日的MEDLINE、Embase、Cochrane和科学引文索引数据库。对纳入研究进行系统评价，并提取数据进行汇总分析。
在检索的1688篇文章中，筛选了47篇全文文章，纳入24项研究（12346例TAVI病例）进行分析。手术死亡率的合并c统计量（95%置信区间）为欧洲心脏手术风险评估系统（EuroSCORE）0.62（0.57 - 0.67）、欧洲心脏手术风险评估系统二代（EuroSCORE II）0.62（0.59 - 0.66）、胸外科医师协会（STS）评分0.62（0.59 - 0.65）。合并校准优势比（95%CI）为EuroSCORE 0.31（0.25 - 0.38）、EuroSCORE II 1.26（1.06 - 1.51）、STS 0.95（0.72 - 1.27）。1年死亡率的c统计量（95%CI）为EuroSCORE 0.62（0.57 - 0.67）、EuroSCORE II 0.66（0.61 - 0.71）和STS评分0.58（0.53 - 0.64）。
手术风险评分对手术死亡率和1年死亡率的区分能力至多为中等。EuroSCORE严重高估了手术死亡率，而EuroSCORE II和STS评分虽有自身局限性，但与TAVI结果拟合得更好。需要开发和验证TAVI特异性风险模型。
