ClinicalComparison between Society of Thoracic Surgeons Score and logistic EuroSCORE for predicting mortality in patients referred for transcatheter aortic valve implantation
Introduction
Transcatheter aortic valve implantation (TAVI) was recently shown to improve outcomes in high-risk or inoperable patients with severe, symptomatic aortic stenosis as compared to medical treatment or balloon aortic valvuloplasty (BAV) [1]. Because the use of TAVI is limited to such patients, the definition of “high-risk or inoperable” is crucial.
To be included in a current randomized TAVI trial and/or registry (PARTNER trial), a patient candidate must have a Society of Thoracic Surgeons (STS) risk score of >10 or a logistic EuroSCORE of >20. Both were developed to assess mortality risk for cardiac surgical procedures. The EuroSCORE is based on mortality from all cardiac surgery; however, patients undergoing coronary bypass surgery constituted the great majority of the data set used in its design. It has, however, been shown to predict long-term mortality after valve surgery [2]. It is pertinent that the STS score is superior to the EuroSCORE for determining mortality in high-risk patients undergoing isolated aortic valve replacement (AVR) [3]. In low-risk patients, the estimated mortality is similar for the two scores, but in high-risk patients, the estimated mortality varies considerably depending on the risk model employed.
Here we compare the accuracy of the STS and logistic EuroSCOREs in predicting 30-day mortality in three groups of high-risk patients with severe aortic stenosis who were referred for possible entry into a TAVI trial. Group assignment was made based on a complete cardiovascular evaluation.
Section snippets
Methods
This prospective cohort study was approved by the Institutional Review Board of the MedStar Health Research Institute and Washington Hospital Center. We consecutively enrolled 718 patients with symptomatic severe aortic stenosis who were referred for TAVI consideration from April 2007 to July 2010. All data were prospectively entered into a dedicated database. All patients underwent systematic screening, including clinical examination, electrocardiogram, laboratory assessment and
Results
The 718 patients were divided into three cohorts: (a) medical/BAV [n=474 (66%)], (b) surgical AVR [n=133 (18.5%)] and (c) TAVI [n=111 (15.4%)]. Their baseline, laboratory and hemodynamic parameters are summarized in Table 1. They were nearly evenly divided with regard to gender as 54.8% were female. As a group, they exhibited not only advanced age (mean, 81.8±8.0 years) but also considerable comorbidity: diabetes, 243 (33.8%); renal failure, 285 (39.6%); and peripheral vascular disease, 207
Discussion
In this series of patients with severe, symptomatic aortic stenosis and high or prohibitive surgical risk, neither the STS nor the logistic EuroSCORE demonstrated an optimal ability to predict 30-day mortality. The ROC curve analysis demonstrated that STS score was superior in patients managed with medications and/or BAV as well as in those who underwent operative AVR (Table 2). In patients treated with TAVI, the ROC analysis using both risk scores for 30-day mortality risk gave equal
References (15)
- et al.
EuroSCORE predicts long-term mortality after heart valve surgery
Ann Thorac Surg
(2005) - et al.
Is the European System for Cardiac Operative Risk Evaluation model valid for estimating the operative risk of patients considered for percutaneous aortic valve replacement?
J Thorac Cardiovasc Surg
(2008) - et al.
Reliability of risk algorithms in predicting early and late operative outcomes in high-risk patients undergoing aortic valve replacement
J Thorac Cardiovasc Surg
(2008) - et al.
Relationship between the logistic EuroSCORE and the Society of Thoracic Surgeons predicted risk of mortality score in patients implanted with the CoreValve ReValving system — a Bern–Rotterdam study
Am Heart J
(2010) - et al.
Transcatheter aortic-valve implantation for aortic stenosis in patients who cannot undergo surgery
N Engl J Med
(2010) - et al.
Society of Thoracic Surgeons score is superior to the EuroSCORE determining mortality in high risk patients undergoing isolated aortic valve replacement
Ann Thorac Surg
(2009) - et al.
Recommendations for quantitation of the left ventricle by two-dimensional echocardiography. American Society of Echocardiography Committee on Standards, Subcommittee on Quantitation of Two-Dimensional Echocardiograms
J Am Soc Echocardiogr
(1989)