title: Performance analysis of EuroSCORE II compared to the original logistic EuroSCORE and STS scores for predicting 30-day mortality after transcatheter aortic valve replacement.
abstract: The original European System for Cardiac Operative Risk Evaluation (EuroSCORE) has been recently updated as EuroSCORE II to optimize its efficacy in cardiac surgery, but its performance has been poorly evaluated for predicting 30-day mortality in patients who undergo transcatheter aortic valve replacement (TAVR). Consecutive patients (n = 250) treated with TAVR were included in this analysis. Transapical access was used in 60 patients, while 190 procedures were performed using a transfemoral approach. Calibration (risk-adjusted mortality ratio) and discrimination (C-statistic and U-statistic) were calculated for the logistic EuroSCORE, EuroSCORE II, and Society of Thoracic Surgeons (STS) scores for predicting 30-day mortality. Observed mortality was 7.6% in the overall population (6.3% and 11.7% for the transfemoral and transapical cohorts, respectively). Predicted mortality was 22.6 ± 12.8% by logistic EuroSCORE, 7.7 ± 5.8% by EuroSCORE II, and 7.3 ± 4.1% by STS score. The risk-adjusted mortality ratio was 0.34 (95% confidence interval [CI] 0.10 to 0.58) for logistic EuroSCORE, 0.99 (95% CI 0.29 to 1.69) for EuroSCORE II, and 1.05 (95% CI 0.30 to 1.79) for STS score. Moderate discrimination was observed with EuroSCORE II (C-index 0.66, 95% CI 0.52 to 0.79, p = 0.02) compared to the logistic EuroSCORE (C-index 0.63, 95% CI 0.51 to 0.76, p = 0.06) and STS (C-index 0.58, 95% CI 0.43 to 0.73, p = 0.23) score, without a significant difference among the 3 risk scores. Discrimination was slightly better in the transfemoral cohort compared to the transapical cohort with the 3 risk scores. In conclusion, EuroSCORE II and the STS score are better calibrated than the logistic EuroSCORE but have moderate discrimination for predicting 30-day mortality after TAVR.
authors: Department of Cardiology, University Hospital of Rouen, Hospital Charles Nicolle, INSERM UMR 1096, Rouen, France.
authors: Eric
authors: E
authors: Durand
authors: Bogdan
authors: B
authors: Borz
authors: Matthieu
authors: M
authors: Godin
authors: Christophe
authors: C
authors: Tron
authors: Pierre-Yves
authors: PY
authors: Litzler
authors: Jean-Paul
authors: JP
authors: Bessou
authors: Jean-Nicolas
authors: JN
authors: Dacher
authors: Fabrice
authors: F
authors: Bauer
authors: Alain
authors: A
authors: Cribier
authors: Hélène
authors: H
authors: Eltchaninoff
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000465:Algorithms; D001024:Aortic Valve Stenosis / Q000401:mortality* / Q000601:surgery*; D006328:Cardiac Catheterization / Q000401:mortality*; D002423:Cause of Death; D003627:Data Interpretation, Statistical; D005260:Female; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000401:mortality*; D006801:Humans; D008297:Male; D011237:Predictive Value of Tests; D011446:Prospective Studies; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D012720:Severity of Illness Index; D016896:Treatment Outcome