Department of Cardiovascular Medicine, Kokura Memorial Hospital, Kitakyushu, Japan.
Department of Cardiovascular Medicine, Kokura Memorial Hospital, Kitakyushu, Japan.
Am J Cardiol. 2021 Jun 15;149:86-94. doi: 10.1016/j.amjcard.2021.03.027. Epub 2021 Mar 20.
The Society of Thoracic Surgeons (STS) risk model, designed to predict operative mortality after cardiac surgery, is often used for the risk assessment of patients considered for transcatheter aortic valve implantation (TAVI). We investigated the long-term prognostic value of the STS score by utilizing the data of 2588 patients undergoing TAVI from the OCEAN (Optimized CathEter vAlvular iNtervention)-TAVI Japanese multicenter registry. The patients were divided into 3 groups according to their pre-procedural STS score as follows: low-risk (STS score <4%, n = 467 [18%]), intermediate-risk (4%≤ STS score <8%, n = 1200 [46.4%]), and high-risk (8%≤ STS score, n = 921 [35.6%]). Low-risk patients were younger and were more frequently male. The prevalence of most of the comorbidities were higher in high-risk patients, while active cancer was more frequent in low-risk patients (p <0.001).The cumulative 4-year all-cause mortality rates were higher in high-risk patients (49.0%) but comparable in low-risk (22.6%) and intermediate-risk patients (28.7%) (hazard ratio [HR] for intermediate-risk versus low-risk, 1.03; 95% confidence interval [CI], 0.77 to 1.37; p = 0.85; HR for high-risk versus low-risk, 2.27; 95% CI 1.72 to 2.99; p = <0.001). Similarly, the cumulative 4-year cardiovascular mortality rates were higher in high-risk patients (20.5%) but comparable in low-risk (9.9%) and intermediate-risk patients (10.3%) (HR for intermediate-risk versus low-risk, 1.10; 95% CI, 0.68 to 1.77; p = 0.69; HR for high-risk versus low-risk, 2.33; 95% CI 1.48 to 3.67; p = <0.001). After adjustment for several confounders, STS score ≥8% was independently associated with increased long-term mortality (HR, 1.35; 95% CI, 1.08 to 1.68). In conclusion, the risk stratification according to STS score demonstrated an increased risk of long-term mortality after TAVI in high-risk patients, albeit with comparable risks in intermediate- and low-risk patients.
胸外科医师学会（STS）风险模型旨在预测心脏手术后的手术死亡率，常用于评估接受经导管主动脉瓣植入术（TAVI）的患者的风险。我们利用来自 OCEAN（优化经导管瓣膜介入治疗- TAVI）日本多中心注册登记的 2588 例 TAVI 患者的数据，研究了 STS 评分的长期预后价值。患者根据术前 STS 评分分为三组：低危组（STS 评分<4%，n=467 [18%]）、中危组（4%≤STS 评分<8%，n=1200 [46.4%]）和高危组（8%≤STS 评分，n=921 [35.6%]）。低危组患者年龄较小，且男性居多。高危组患者的大多数合并症患病率较高，而低危组患者的活动性癌症更为常见（p<0.001）。高危组患者的 4 年累积全因死亡率较高（49.0%），但中危组（28.7%）和低危组（22.6%）患者的死亡率相似（中危组与低危组的风险比 [HR]，1.03；95%置信区间 [CI]，0.77 至 1.37；p=0.85；高危组与低危组的 HR，2.27；95%CI 1.72 至 2.99；p<0.001）。同样，高危组患者的 4 年累积心血管死亡率较高（20.5%），但中危组（10.3%）和低危组（9.9%）患者的死亡率相似（中危组与低危组的 HR，1.10；95%CI，0.68 至 1.77；p=0.69；高危组与低危组的 HR，2.33；95%CI 1.48 至 3.67；p<0.001）。在校正了几个混杂因素后，STS 评分≥8%与 TAVI 后长期死亡率增加独立相关（HR，1.35；95%CI，1.08 至 1.68）。总之，根据 STS 评分进行风险分层显示，高危患者 TAVI 后长期死亡风险增加，而中危和低危患者的风险相似。
