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Valvular heart disease
Original research article
Novel United Kingdom prognostic model for 30-day mortality following transcatheter aortic valve implantation
  1. Glen P Martin1,
  2. Matthew Sperrin1,
  3. Peter F Ludman2,
  4. Mark A de Belder3,
  5. Simon R Redwood4,
  6. Jonathan N Townend2,
  7. Mark Gunning5,
  8. Neil E Moat6,
  9. Adrian P Banning7,
  10. Iain Buchan1,
  11. Mamas A Mamas1,5
  1. 1 Faculty of Biology, Medicine and Health, Farr Institute, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
  2. 2 Cardiology Department, Queen Elizabeth Hospital, Birmingham, UK
  3. 3 Cardiology Department, James Cook University Hospital, Middlesbrough, UK
  4. 4 Cardiology Department, Guys and St Thomas' NHS Foundation Trust, London, UK
  5. 5 Keele Cardiovascular Research Group, Keele University, Stoke-on-Trent, UK
  6. 6 Cardiology Department, Royal Brompton and Harefield National Health Service (NHS) Foundation Trust, London, UK
  7. 7 Cardiology Department, John Radcliffe Hospital, Oxford, UK
  1. Correspondence to Prof. Mamas A Mamas, Keele Cardiovascular Research Group, Centre for Prognosis Research, Institute for Primary Care and Health Sciences, Keele University, Stoke-on-Trent, ST4 7QB, UK; mamasmamas1{at}yahoo.co.uk

Abstract

Objective Existing clinical prediction models (CPM) for short-term mortality after transcatheter aortic valve implantation (TAVI) have limited applicability in the UK due to moderate predictive performance and inconsistent recording practices across registries. The aim of this study was to derive a UK-TAVI CPM to predict 30-day mortality risk for benchmarking purposes.

Methods A two-step modelling strategy was undertaken: first, data from the UK-TAVI Registry between 2009 and 2014 were used to develop a multivariable logistic regression CPM using backwards stepwise regression. Second, model-updating techniques were applied using the 2013–2014 data, thereby leveraging new approaches to include frailty and to ensure the model was reflective of contemporary practice. Internal validation was performed by bootstrapping to estimate in-sample optimism-corrected performance.

Results Between 2009 and 2014, up to 6339 patients were included across 34 centres in the UK-TAVI Registry (mean age, 81.3; 2927 female (46.2%)). The observed 30-day mortality rate was 5.14%. The final UK-TAVI CPM included 15 risk factors, which included two variables associated with frailty. After correction for in-sample optimism, the model was well calibrated, with a calibration intercept of 0.02 (95% CI −0.17 to 0.20) and calibration slope of 0.79 (95% CI 0.55 to 1.03). The area under the receiver operating characteristic curve, after adjustment for in-sample optimism, was 0.66.

Conclusion The UK-TAVI CPM demonstrated strong calibration and moderate discrimination in UK-TAVI patients. This model shows potential for benchmarking, but even the inclusion of frailty did not overcome the need for more wide-ranging data and other outcomes might usefully be explored.

  • aortic stenosis
  • transcatheter valve interventions

This is an Open Access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY 4.0) license, which permits others to distribute, remix, adapt and build upon this work, for commercial use, provided the original work is properly cited. See: http://creativecommons.org/licenses/by/4.0/

https://doi.org/10.1136/heartjnl-2017-312489

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    Footnotes

    • Contributors GPM, MS and MAM made substantial contributions to the concept of the work in addition to designing and performing the analysis. GPM drafted the initial version of the manuscript. All of the authors interpreted the results, revised the paper critically for important intellectual content and approved the final version of the paper.

    • Funding This work was funded by the Medical Research Council through the Health e-Research Centre, University of Manchester (MR/K006665/1) and a grant through the North Staffordshire Heart Committee.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.