title: Inaccuracy of available surgical risk scores to predict outcomes after transcatheter aortic valve replacement.
abstract: BACKGROUND
  Despite encouraging short-term and mid-term results, transcatheter aortic valve implantation (TAVI) interventions are still burdened from high rates of adverse events, stressing the need for accurate predictive risk instruments. We compared available surgical risk scores to describe unfavorable outcomes after TAVI.
  
  
  METHODS
  The Age, Creatinine, and Ejection fraction (ACEF) score, the logistic Euroscore, and the Society of Thoracic Surgeons Mortality score (STS) were appraised for their independent power of prediction and for their accuracy (C-index) to predict 30-day and medium-term mortality, according to the Valve Academic Research Consortium.
  
  
  RESULTS
  Nine hundred and sixty-two patients were included. All the scores demonstrated a moderate positive correlation. The closest correlation was observed between the STS score and Euroscore. After logistic regression analysis, STS score and Logistic Euroscore provided independent prediction for short-term all-cause mortality [P = 0.02, odds ratio (OR) 1.1; 95% confidence interval (CI) 1.06-1.31 and P = 0.027, OR 1.03; 95% CI 1.01-1.405]. For in-hospital complications, only STS score performed significantly (P = 0.005, OR 1.05; 95% CI 1.01-1.06). ACEF, Euroscore, and STS score showed low accuracy for 30-day all-cause mortality (area under the curve 0.6, 0.44-0.75; vs. 0.53, 0.42-0.61; vs. 0.62, 0.52-0.71, respectively), whereas STS score performed better for in-hospital complications (0.59, 0.55-0.64). Moreover, after Cox-multivariate adjustments, only ACEF score was near to significance to predict all-cause mortality at mid-term (OR 1.7; 0.8-2.9; P = 0.058), showing the highest accuracy (0.63, 0.55-0.71).
  
  
  CONCLUSIONS
  In TAVI patients, ACEF score, STS score and Logistic Euroscore provided only a moderate correlation and a low accuracy both for 30-day and medium-term outcomes. Dedicated scores are needed to properly tailor time and kind of approach.
authors.affiliation: aDivision of Cardiology, Department of Internal Medicine, Città Della Salute e Della Scienza bDivision of Cardiac-Surgery, San Giovanni Battista Molinette, University of Turin, Turin cDivision of Cardiology, Azienda Ferrarotto Hospital, University of Catania, Catania dDepartment of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Rome eDivision of Cardiology, Istituto Clinico Humanitas, Milan fDivision of Cardiology, Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, Padova, Italy.
authors.forename: Fabrizio
authors.initials: F
authors.lastname: D'Ascenzo
authors.forename: Flavia
authors.initials: F
authors.lastname: Ballocca
authors.forename: Claudio
authors.initials: C
authors.lastname: Moretti
authors.forename: Marco
authors.initials: M
authors.lastname: Barbanti
authors.forename: Valeria
authors.initials: V
authors.lastname: Gasparetto
authors.forename: Marco
authors.initials: M
authors.lastname: Mennuni
authors.forename: Maurizio
authors.initials: M
authors.lastname: D'Amico
authors.forename: Federico
authors.initials: F
authors.lastname: Conrotto
authors.forename: Stefano
authors.initials: S
authors.lastname: Salizzoni
authors.forename: Pierluigi
authors.initials: P
authors.lastname: Omedè
authors.forename: Chiara
authors.initials: C
authors.lastname: Colaci
authors.forename: Giuseppe B
authors.initials: GB
authors.lastname: Zoccai
authors.forename: Mario
authors.initials: M
authors.lastname: Lupo
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Tarantini
authors.forename: Massimo
authors.initials: M
authors.lastname: Napodanno
authors.forename: Patrizia
authors.initials: P
authors.lastname: Presbitero
authors.forename: Imad
authors.initials: I
authors.lastname: Sheiban
authors.forename: Corrado
authors.initials: C
authors.lastname: Tamburino
authors.forename: Sebastiano
authors.initials: S
authors.lastname: Marra
authors.forename: Fiorenzo
authors.initials: F
authors.lastname: Gaita
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001024:Aortic Valve Stenosis / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D006328:Cardiac Catheterization / Q000009:adverse effects / Q000401:mortality; D005260:Female; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects* / Q000379:methods / Q000401:mortality; D006801:Humans; D007558:Italy / Q000453:epidemiology; D008297:Male; D011379:Prognosis; D018570:Risk Assessment / Q000379:methods; D012720:Severity of Illness Index; D016896:Treatment Outcome; D014463:Ultrasonography