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The multiparametric FRANCE-2 risk score: one step further in improving the clinical decision-making process in transcatheter aortic valve implantation
  1. Henrique B Ribeiro,
  2. Josep Rodés-Cabau
  1. Quebec Heart & Lung Institute, Laval University, Quebec City, Quebec, Canada
  1. Correspondence to Dr Josep Rodés-Cabau, Quebec Heart & Lung Institute, Laval University, 2725 Chemin Ste-Foy, Quebec City, Quebec, Canada G1V 4G5; josep.rodes{at}criucpq.ulaval.ca

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Models of prognostic risk prediction have been widely used in the cardiovascular field, and several risk scores have been developed to predict the risk of short-term mortality associated with cardiac surgery on the basis of patients’ preoperative characteristics (table 1).1–8 Historically, the Society of Thoracic Surgeons Predicted Risk of Mortality (STS-PROM) score and the logistic European System for Cardiac Operative Risk Evaluation (EuroSCORE, now replaced by the EuroSCORE II) have been the most commonly used. These scores are simple to apply and have been widely adopted in the decision-making process of patients being evaluated for cardiac surgery.

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Table 1

Main features from selected cardiac surgical risk scores*

Transcatheter aortic valve implantation (TAVI) has emerged as a less invasive treatment for patients with severe symptomatic aortic stenosis, and surgical risk scores have been widely used to identify those patients at high or prohibitive surgical risk who may benefit from this procedure.9 Therefore, the inclusion of patients in registries and randomised trials in the TAVI field has been mainly based on such surgical risk scores (particularly, the EuroSCORE and STS-PROM score), in addition to a thorough evaluation of the patient by the heart team. Furthermore, several studies have determined the potential usefulness of using such risk scores to predict clinical outcomes following TAVI, but they have systematically shown a relatively low accuracy, particularly the logistic EuroSCORE and the STS-PROM score, in the prediction of acute and midterm mortality (table 2).10–13 Also, no data exist on the prospective validation of surgical risk scores in the TAVI population. In fact, many …

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