title: ESC Working Group on Valvular Heart Disease Position Paper: assessing the risk of interventions in patients with valvular heart disease.
abstract: OBJECTIVE
  Risk scores provide an important contribution to clinical decision-making, but their validity has been questioned in patients with valvular heart disease (VHD), since current scores have been mainly derived and validated in adults undergoing coronary bypass surgery. The Working Group on Valvular Heart Disease of the European Society of Cardiology reviewed the performance of currently available scores when applied to VHD, in order to guide clinical practice and future development of new scores.
  
  
  RESULTS
  The most widely used risk scores (EuroSCORE, STS, and Ambler score) were reviewed, analysing variables included and their predictive ability when applied to patients with VHD. These scores provide relatively good discrimination, i.e. a gross estimation of risk category, but cannot be used to estimate the exact operative mortality in an individual patient because of unsatisfactory calibration.
  
  
  CONCLUSIONS
  Current risk scores do not provide a reliable estimate of exact operative mortality in an individual patient with VHD. They should therefore be interpreted with caution and only used as part of an integrated approach, which incorporates other patient characteristics, the clinical context, and local outcome data. Future risk scores should include additional variables, such as cognitive and functional capacity and be prospectively validated in high-risk patients. Specific risk models should also be developed for newer interventions, such as transcatheter aortic valve implantation.
authors.affiliation: Department of Cardiology, Medical University of Vienna, Vienna, Austria. raphael.rosenhek@meduniwien.ac.at
authors.forename: Raphael
authors.initials: R
authors.lastname: Rosenhek
authors.forename: Bernard
authors.initials: B
authors.lastname: Iung
authors.forename: Pilar
authors.initials: P
authors.lastname: Tornos
authors.forename: Manuel J
authors.initials: MJ
authors.lastname: Antunes
authors.forename: Bernard D
authors.initials: BD
authors.lastname: Prendergast
authors.forename: Catherine M
authors.initials: CM
authors.lastname: Otto
authors.forename: Arie Pieter
authors.initials: AP
authors.lastname: Kappetein
authors.forename: Janina
authors.initials: J
authors.lastname: Stepinska
authors.forename: Jens J
authors.initials: JJ
authors.lastname: Kaden
authors.forename: Christoph K
authors.initials: CK
authors.lastname: Naber
authors.forename: Esmeray
authors.initials: E
authors.lastname: Acartürk
authors.forename: Christa
authors.initials: C
authors.lastname: Gohlke-Bärwolf
mesh_terms: D002138:Calibration; D003657:Decision Making; D006349:Heart Valve Diseases / Q000401:mortality / Q000601:surgery*; D019918:Heart Valve Prosthesis Implantation / Q000401:mortality; D006801:Humans; D019990:Perioperative Care / Q000401:mortality; D018570:Risk Assessment / Q000379:methods* / Q000592:standards; D012680:Sensitivity and Specificity; D016896:Treatment Outcome