title: Development of a risk score for outcome after transcatheter aortic valve implantation.
abstract: OBJECTIVE
  Transcatheter aortic valve implantation (TAVI) is an increasingly common procedure in elderly and multimorbid patients with aortic stenosis. We aimed at developing a pre-procedural risk evaluation scheme beyond current surgical risk scores.
  
  
  METHODS
  We developed a risk algorithm for 1-year mortality in two cohorts consisting of 845 patients undergoing routine TAVI procedures by commercially available devices, mean age 80.9 ± 6.5, 51 % women. Clinical variables were determined at baseline. Multivariable Cox regression related clinical data to mortality (n = 207 deaths).
  
  
  RESULTS
  To account for variability related to age and sex and by enrolment site we forced age, sex, and cohort into the score model. Body mass index, estimated glomerular filtration rate, hemoglobin, pulmonary hypertension, mean transvalvular gradient and left ventricular ejection fraction at baseline were most strongly associated with mortality and entered the risk prediction algorithm [C-statistic 0.66, 95 % confidence interval (CI) 0.61-0.70, calibration χ (2)-statistic = 6.51; P = 0.69]. Net reclassification improvement compared to existing surgical risk predication schemes was positive. The score showed reasonable model fit and calibration in external validation in 333 patients, N = 55 deaths (C-statistic 0.60, 95 % CI 0.52-0.68; calibration χ (2)-statistic = 16.2; P = 0.06). Additional measurement of B-type natriuretic peptide and troponin I did not improve the C-statistic. Frailty increased the C-statistic to 0.71, 95 % CI 0.65-0.76.
  
  
  CONCLUSIONS
  We present a new risk evaluation tool derived and validated in routine TAVI cohorts that predicts 1-year mortality. Biomarkers only marginally improved risk prediction. Frailty increased the discriminatory ability of the score and needs to be considered. Risk algorithms specific for TAVI may help to guide decision-making when patients are evaluated for TAVI.
authors.affiliation: Department of General and Interventional Cardiology, University Heart Center Hamburg-Eppendorf, Building East 70 (O70), Martinistrasse 52, 20246, Hamburg, Germany.
authors.forename: Moritz
authors.initials: M
authors.lastname: Seiffert
authors.forename: Jan-Malte
authors.initials: JM
authors.lastname: Sinning
authors.forename: Alexander
authors.initials: A
authors.lastname: Meyer
authors.forename: Sandra
authors.initials: S
authors.lastname: Wilde
authors.forename: Lenard
authors.initials: L
authors.lastname: Conradi
authors.forename: Mariuca
authors.initials: M
authors.lastname: Vasa-Nicotera
authors.forename: Alexander
authors.initials: A
authors.lastname: Ghanem
authors.forename: Jörg
authors.initials: J
authors.lastname: Kempfert
authors.forename: Christoph
authors.initials: C
authors.lastname: Hammerstingl
authors.forename: Francisco M
authors.initials: FM
authors.lastname: Ojeda
authors.forename: Won-Keun
authors.initials: WK
authors.lastname: Kim
authors.forename: Dietmar H
authors.initials: DH
authors.lastname: Koschyk
authors.forename: Johannes
authors.initials: J
authors.lastname: Schirmer
authors.forename: Stephan
authors.initials: S
authors.lastname: Baldus
authors.forename: Eberhard
authors.initials: E
authors.lastname: Grube
authors.forename: Helge
authors.initials: H
authors.lastname: Möllmann
authors.forename: Hermann
authors.initials: H
authors.lastname: Reichenspurner
authors.forename: Georg
authors.initials: G
authors.lastname: Nickenig
authors.forename: Stefan
authors.initials: S
authors.lastname: Blankenberg
authors.forename: Patrick
authors.initials: P
authors.lastname: Diemert
authors.forename: Hendrik
authors.initials: H
authors.lastname: Treede
authors.forename: Thomas
authors.initials: T
authors.lastname: Walther
authors.forename: Nikos
authors.initials: N
authors.lastname: Werner
authors.forename: Renate B
authors.initials: RB
authors.lastname: Schnabel
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000465:Algorithms; D001024:Aortic Valve Stenosis / Q000601:surgery*; D015415:Biomarkers / Q000378:metabolism; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D016330:Frail Elderly; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D017063:Outcome Assessment, Health Care; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012042:Registries; D018570:Risk Assessment; D012307:Risk Factors; D065467:Transcatheter Aortic Valve Replacement / Q000379:methods*
chemical_list: D015415:Biomarkers