Department of Cardiac Surgery, Kerckhoff Heart Center, Bad Nauheim, Germany.
EuroIntervention. 2018 Jan 20;13(13):1520-1526. doi: 10.4244/EIJ-D-17-00421.
The aim of this study was to validate the recently developed STS/ACC TAVR in-hospital mortality risk score for predicting in-hospital mortality after transcatheter aotic valve implantation (TAVI) and to compare its ability to predict 30-day mortality with that of four other established risk models (EuroSCORE I, EuroSCORE II, STS-PROM, and German AV Score).
The study cohort included 946 consecutive patients who underwent TAVI between 2013 and 2015. Each of the five scores was fitted as a continuous linear variable into a logistic regression model estimating 30-day mortality. The STS/ACC TAVR score was additionally analysed for in-hospital mortality. C-statistics and likelihood ratio (LR) test p-values were estimated for each model to describe the model fit. The ability of the STS/ACC score to predict in-hospital mortality was similar to the reported STS/ACC TVT registry data (this study's C-statistic 0.65 vs. STS/ACC TVT registry 0.66). The STS-PROM score (C-statistic=0.68; LR p<0.0001) and the new STS/ACC TAVR score (C-statistic=0.68; LR p<0.0001) were superior to the other scores (EuroSCORE I [C-statistic=0.55; LR p=0.02], EuroSCORE II [C-statistic=0.58; LR p=0.02], German AV Score [C-statistic=0.62; LR p<0.01]) for prediction of 30-day mortality.
These data show the superiority of the STS-PROM and STS/ACC TAVR scores compared with other existing risk calculation models in predicting 30-day mortality after TAVI in a German all-comers population. The STS/ACC TAVR score, however, is easier to calculate (12 vs. 28 variables), and may thus gain wider acceptance and be accompanied by improved inter-observer reliability.
本研究旨在验证最近开发的 STS/ACC TAVR 院内死亡率风险评分，以预测经导管主动脉瓣植入术（TAVI）后的院内死亡率，并比较其预测 30 天死亡率的能力与其他四个已建立的风险模型（EuroSCORE I、EuroSCORE II、STS-PROM 和德国 AV 评分）。
本研究队列纳入了 2013 年至 2015 年间接受 TAVI 的 946 例连续患者。将五个评分中的每一个都拟合为一个连续线性变量，纳入一个逻辑回归模型，以估计 30 天死亡率。还对 STS/ACC TAVR 评分进行了院内死亡率分析。为每个模型估计了 C 统计量和似然比（LR）检验 p 值，以描述模型拟合度。STS/ACC 评分预测院内死亡率的能力与报告的 STS/ACC TVT 登记数据相似（本研究的 C 统计量为 0.65，STS/ACC TVT 登记为 0.66）。STS-PROM 评分（C 统计量=0.68；LR p<0.0001）和新的 STS/ACC TAVR 评分（C 统计量=0.68；LR p<0.0001）优于其他评分（EuroSCORE I [C 统计量=0.55；LR p=0.02]、EuroSCORE II [C 统计量=0.58；LR p=0.02]、德国 AV 评分 [C 统计量=0.62；LR p<0.01]），可更好地预测 TAVI 后 30 天死亡率。
这些数据表明，在德国所有患者人群中，STS-PROM 和 STS/ACC TAVR 评分在预测 TAVI 后 30 天死亡率方面优于其他现有风险计算模型。然而，STS/ACC TAVR 评分计算更简单（12 个变量与 28 个变量），因此可能会得到更广泛的认可，并提高观察者间的可靠性。
