欧洲心脏手术风险评估系统II（EuroSCORE II）和胸外科医师协会（STS）评分在经心尖经导管主动脉瓣植入术中比在经股动脉经导管主动脉瓣植入术中更准确。
EuroSCORE II and the STS score are more accurate in transapical than in transfemoral transcatheter aortic valve implantation.
作者信息
Kofler Markus, Reinstadler Sebastian J, Stastny Lukas, Dumfarth Julia, Reindl Martin, Wachter Kristina, Rustenbach Christian J, Müller Silvana, Feuchtner Gudrun, Friedrich Guy, Metzler Bernhard, Grimm Michael, Bonaros Nikolaos, Baumbach Hardy
机构信息
University Clinic of Cardiac Surgery, Medical University of Innsbruck, Innsbruck, Austria.
University Clinic of Internal Medicine III, Cardiology and Angiology, Medical University of Innsbruck, Innsbruck, Austria.
出版信息
Interact Cardiovasc Thorac Surg. 2018 Mar 1;26(3):413-419. doi: 10.1093/icvts/ivx343.
OBJECTIVES
The European System for Cardiac Operative Risk Evaluation II (EuroSCORE II) and the Society of Thoracic Surgeons (STS) score are currently used to estimate periprocedural risk of death in patients undergoing transcatheter aortic valve implantation (TAVI). However, data regarding the predictive ability and usefulness of these scores for TAVI are controversial, especially for different access sites.
METHODS
Between 2008 and 2016, 1192 consecutive patients undergoing TAVI [transfemoral (TF): n = 607 (51%); transapical (TA): n = 585 (49%)] at 2 centres were included. All-cause mortality was assessed at a median of 533 days (interquartile range 153-1036). The value of the EuroSCORE II and the STS score in terms of predicting 30-day and cumulative mortality according to access site was investigated.
RESULTS
The mean age was 83 (interquartile range 79-86) years. Overall, the 30-day mortality rate was 7.6% (n = 90), and the cumulative all-cause mortality rate was 35.1% (n = 418). The EuroSCORE II and the STS score were significantly increased in non-survivors compared with survivors (P < 0.001). The EuroSCORE II and the STS score emerged as independent predictors of 30-day mortality [EuroSCORE II: odds ratio (OR) 1.039, 95% confidence interval (CI) 1.013-1.065; P = 0.003; STS score: OR 1.055, 95% CI 1.023-1.088; P = 0.001] and cumulative all-cause mortality [EuroSCORE II: hazard ratio (HR) 1.026, 95% CI 1.013-1.038; P < 0.001; STS score: HR 1.05, 95% CI 1.03-1.06; P < 0.001]. In contrast to TF TAVI, the EuroSCORE II (OR 1.038, 95% CI 1.009-1.068; P = 0.010) and the STS score (OR: 1.063, 95% CI 1.025-1.102; P = 0.001) were independent predictors of 30-day mortality and cumulative mortality (EuroSCORE II: HR 1.023, 95% CI 1.009-1.037; P = 0.001; STS score: HR 1.055, 95% CI 1.037-1.073; P < 0.001) in patients undergoing TA TAVI.
CONCLUSIONS
The EuroSCORE II and the STS score were independent predictors of 30-day and cumulative mortality rates in patients undergoing TAVI. The EuroSCORE II and the STS score were associated with 30-day mortality and mortality during follow-up period only in TA TAVI.
目的
欧洲心脏手术风险评估系统II（EuroSCORE II）和胸外科医师协会（STS）评分目前用于估计经导管主动脉瓣植入术（TAVI）患者围手术期死亡风险。然而，关于这些评分对TAVI的预测能力和实用性的数据存在争议，尤其是对于不同的入路部位。
方法
2008年至2016年期间，纳入了在2个中心连续接受TAVI的1192例患者[经股动脉（TF）：n = 607例（51%）；经心尖（TA）：n = 585例（49%）]。在中位时间533天（四分位间距153 - 1036天）时评估全因死亡率。研究了EuroSCORE II和STS评分根据入路部位预测30天和累积死亡率的价值。
结果
平均年龄为83岁（四分位间距79 - 86岁）。总体而言，30天死亡率为7.6%（n = 90），累积全因死亡率为35.1%（n = 418）。与存活者相比，非存活者的EuroSCORE II和STS评分显著升高（P < 0.001）。EuroSCORE II和STS评分成为30天死亡率的独立预测因素[EuroSCORE II：比值比（OR）1.039，95%置信区间（CI）1.013 - 1.065；P = 0.003；STS评分：OR 1.055，95% CI 1.023 - 1.088；P = 0.001]和累积全因死亡率[EuroSCORE II：风险比（HR）1.026，95% CI 1.013 - 1.038；P < 0.001；STS评分：HR 1.05，95% CI 1.03 - 1.06；P < 0.001]。与经股动脉TAVI不同，EuroSCORE II（OR 1.038，95% CI 1.009 - 1.068；P = 0.010）和STS评分（OR：1.063，95% CI 1.025 - 1.102；P = 0.001）是接受经心尖TAVI患者30天死亡率和累积死亡率的独立预测因素（EuroSCORE II：HR 1.023，95% CI 1.009 - 1.037；P = 0.001；STS评分：HR 1.055，95% CI 1.037 - 1.073；P < 0.001）。
结论
EuroSCORE II和STS评分是TAVI患者30天和累积死亡率的独立预测因素。EuroSCORE II和STS评分仅在经心尖TAVI中与30天死亡率和随访期间死亡率相关。
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