Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, OH (A.K., K.S., J.N., K.B., K.A., C.L., D.M., A.K.A., A.C.S., V.M., A.K., E.M.T., W.A.J., S.M., L.G.S., S.R.K.).
Division of Cardiovascular Medicine, University of Louisville, KY (A.R.K.).
Circ Cardiovasc Interv. 2018 Sep;11(9):e006664. doi: 10.1161/CIRCINTERVENTIONS.118.006664.
The Society of Thoracic Surgeons (STS) scores are used to screen patients for transcatheter aortic valve replacement (TAVR). The STS scores were also used to risk stratify patients in major TAVR trials. This study evaluates the reclassification of predicted risk of mortality by the currently available online STS score calculator compared with the 2008 STS risk model in patients undergoing TAVR.
All patients who underwent TAVR from 2006 to 2016 were included in the study. The STS scores for all included patients were calculated by applying the 2008 STS risk model and again using the current STS online calculator. Among 1209 patients who underwent TAVR, 30-day mortality was 27 (2.2%). The overall predicted risk of mortality estimated by using the current online STS risk calculator was significantly lower than the 2008 STS risk model (6.3±4.4 vs 7.3±4.9; P<0.001). A total of 235 (19%) patients were reclassified into a lower risk category per the current STS risk model. In a multivariable logistic regression analysis, patients with persistent atrial fibrillation (odds ratio, 1.4; 95% CI, 1.0-1.9; P=0.03), chronic heart failure (odds ratio, 6.0; 95% CI, 3.8-10.1; P<0.001), and New York Heart Association class IV heart failure (odds ratio, 2.4; 95% CI, 1.3-4.4; P=0.007) were more likely to be reclassified into a lower risk category per the current STS risk model.
The current STS calculation method produces significantly lower predicted risk of mortality than the 2008 calculator, more pronounced in patients with certain comorbid conditions. These results should be considered while evaluating data from prior studies of TAVR.
胸外科医师学会（STS）评分用于筛选接受经导管主动脉瓣置换术（TAVR）的患者。STS 评分也用于对大型 TAVR 试验中的患者进行风险分层。本研究评估了目前在线 STS 评分计算器对接受 TAVR 的患者死亡率预测风险的重新分类与 2008 年 STS 风险模型的比较。
所有 2006 年至 2016 年接受 TAVR 的患者均纳入本研究。应用 2008 年 STS 风险模型和当前 STS 在线计算器计算所有纳入患者的 STS 评分。在 1209 例接受 TAVR 的患者中，30 天死亡率为 27（2.2%）。应用当前在线 STS 风险计算器估计的总体死亡率预测风险明显低于 2008 年 STS 风险模型（6.3±4.4 比 7.3±4.9；P<0.001）。根据当前 STS 风险模型，共有 235（19%）例患者被重新分类为低风险类别。在多变量逻辑回归分析中，持续性心房颤动（优势比，1.4；95%置信区间，1.0-1.9；P=0.03）、慢性心力衰竭（优势比，6.0；95%置信区间，3.8-10.1；P<0.001）和纽约心脏协会心功能分级 IV 级心力衰竭（优势比，2.4；95%置信区间，1.3-4.4；P=0.007）的患者更有可能根据当前 STS 风险模型被重新分类为低风险类别。
与 2008 年计算器相比，当前 STS 计算方法产生的死亡率预测风险显著降低，在某些合并症患者中更为明显。在评估 TAVR 先前研究的数据时，应考虑这些结果。
