title: Predictive factors of early mortality after transcatheter aortic valve implantation: individual risk assessment using a simple score.
abstract: OBJECTIVE
  Decision making for intervention in symptomatic aortic stenosis should balance the risks of surgery and of transcatheter aortic valve implantation (TAVI). We identified the factors associated with early mortality after TAVI and aimed to develop and validate a simple risk score.
  
  
  METHODS
  A population of 3833 consecutive patients was randomly split into two cohorts comprising 2552 and 1281 patients, used respectively to develop and validate a scoring system predicting 30-day or in-hospital mortality.
  
  
  RESULTS
  TAVI was performed using the Edwards Sapien prosthesis in 2551 (66.8%) patients and the Medtronic Corevalve in 1270 (33.2%). Approach was transfemoral in 2801 (73.4%) patients, transapical in 678 (17.8%), subclavian in 219 (5.7%) and other in 117 (3.1%). Early mortality was 10.0% (382 patients). A multivariate logistic model identified the following predictive factors of early mortality: age ≥90 years, body mass index <30 Kg/m(2), New York Heart Association class IV, pulmonary hypertension, critical haemodynamic state, ≥2 pulmonary oedemas during the last year, respiratory insufficiency, dialysis and transapical or other (transaortic and transcarotid) approaches. A 21-point predictive score was derived. C-index was 0.67 for the score in the development cohort and 0.59 in the validation cohort. There was a good concordance between predicted and observed 30-day mortality rates in the development and validation cohorts.
  
  
  CONCLUSIONS
  Early mortality after TAVI is mainly related to age, the severity of symptoms, comorbidities and transapical approach. A simple score can be used to predict early mortality after TAVI. The moderate discrimination is however a limitation for the accurate identification of high-risk patients.
authors.affiliation: Cardiology Department, AP-HP, Hôpital Bichat Claude Bernard, Paris, France University Paris Diderot, Sorbonne Paris Cité, Paris, France.
authors.forename: Bernard
authors.initials: B
authors.lastname: Iung
authors.affiliation: University Paris Diderot, Sorbonne Paris Cité, Paris, France Biostatistic Department, AP-HP, Bichat Hospital, Paris, France.
authors.forename: Cédric
authors.initials: C
authors.lastname: Laouénan
authors.affiliation: Cardiology Department, AP-HP, Hôpital Bichat Claude Bernard, Paris, France.
authors.forename: Dominique
authors.initials: D
authors.lastname: Himbert
authors.affiliation: Cardiology Department, Hôpital Charles Nicolle, University of Rouen, INSERM Unité 1096, Rouen, France.
authors.forename: Hélène
authors.initials: H
authors.lastname: Eltchaninoff
authors.affiliation: URC Eco and UPEC EA 4393, AP-HP, Paris, France;
authors.forename: Karine
authors.initials: K
authors.lastname: Chevreul
authors.affiliation: Institut Jacques Cartier, Massy, France.
authors.forename: Patrick
authors.initials: P
authors.lastname: Donzeau-Gouge
authors.affiliation: Clinique Pasteur, Toulouse, France.
authors.forename: Jean
authors.initials: J
authors.lastname: Fajadet
authors.affiliation: Cardiac Surgery Department, AP-HP, Hôpital Pitié-Salpetrière, Paris, France.
authors.forename: Pascal
authors.initials: P
authors.lastname: Leprince
authors.affiliation: Cardiac Surgery Department, CHU Pontchaillou, Rennes, France.
authors.forename: Alain
authors.initials: A
authors.lastname: Leguerrier
authors.affiliation: Université Lyon 1, Lyon, France.
authors.forename: Michel
authors.initials: M
authors.lastname: Lièvre
authors.affiliation: Cardiac Surgery Department, Hôpital Cardiologique, CHU, Lille, France.
authors.forename: Alain
authors.initials: A
authors.lastname: Prat
authors.affiliation: Cardiology Department, AP-HP, Hôpital Henri Mondor, Créteil, France.
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Teiger
authors.affiliation: Cardiovascular Surgery Department, Hôpital Dupuytren, CHU, Limoges, France.
authors.forename: Marc
authors.initials: M
authors.lastname: Laskar
authors.affiliation: Cardiology Department, AP-HP, Hôpital Bichat Claude Bernard, Paris, France University Paris Diderot, Sorbonne Paris Cité, Paris, France.
authors.forename: Alec
authors.initials: A
authors.lastname: Vahanian
authors.affiliation: Cardiology Department, Hôpital de la Cavale Blanche, CHU, Brest, France.
authors.forename: Martine
authors.initials: M
authors.lastname: Gilard
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001024:Aortic Valve Stenosis / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D006328:Cardiac Catheterization / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods / Q000401:mortality*; D015897:Comorbidity; D003661:Decision Support Techniques; D005260:Female; D005602:France; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods / Q000401:mortality*; D017052:Hospital Mortality; D006801:Humans; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D016017:Odds Ratio; D018579:Patient Selection; D011237:Predictive Value of Tests; D011474:Prosthesis Design; D012042:Registries; D015203:Reproducibility of Results; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome