title: The relative performance characteristics of the logistic European System for Cardiac Operative Risk Evaluation score and the Society of Thoracic Surgeons score in the Placement of Aortic Transcatheter Valves trial.
abstract: OBJECTIVE
  The logistic European System for Cardiac Operative Risk Evaluation (LES) score and the Society of Thoracic Surgeons (STS) score are validated to predict 30-day outcomes following surgical aortic valve replacement (SAVR) with or without coronary artery bypass grafting. Their performance when applied to patients undergoing transcatheter aortic valve replacement (TAVR) is controversial.
  
  
  METHODS
  We compared predicted and observed 30-day/in-hospital and 1-year mortality of patients undergoing TAVR in the first Placement of Aortic Transcatheter Valves trial and continued access registry (N = 2466). The performance of the LES and STS scores (prospectively calculated) was evaluated using standard assessments of discrimination and calibration. Performance of STS and LES scores among 307 patients undergoing SAVR from the high-risk cohort of the randomized trial were also examined.
  
  
  RESULTS
  In patients undergoing TAVR, the observed 30-day/in-hospital mortality was 6.5%, whereas the predicted 30-day mortality was higher by both STS score (11.4% ± 3.9%) and LES score (26.6% ± 16.2%). The discrimination for both scores was poor for 30-day/in-hospital and 1-year mortality. Calibration was better for STS score than for LES at 1 year but poor for both at 30 days among TAVR cohort. These results were consistent among the subgroups of patients undergoing transfemoral and transapical access; however, the STS score had better performance among the high-risk patients who underwent SAVR at 30 days but not 1 year.
  
  
  CONCLUSIONS
  The STS and LES surgical risk scores overestimated 30-day/in-hospital mortality and were poor discriminators of post-TAVR mortality, but the calibration of the STS score was better in these high-risk patients. These data highlight the need for TAVR-specific risk models to optimize patient selection.
authors.affiliation: Cardiac Catheterization Laboratory, Columbia University Division of Cardiology, Mount Sinai Medical Center, Miami Beach, Fla. Electronic address: Nirat.Beohar@msmc.com.
authors.forename: Nirat
authors.initials: N
authors.lastname: Beohar
authors.affiliation: Intermountain Medical Center, Salt Lake City, Utah.
authors.forename: Brian
authors.initials: B
authors.lastname: Whisenant
authors.affiliation: Columbia University Medical Center/New York Presbyterian Hospital, New York, NY.
authors.forename: Ajay J
authors.initials: AJ
authors.lastname: Kirtane
authors.affiliation: Columbia University Medical Center/New York Presbyterian Hospital, New York, NY.
authors.forename: Martin B
authors.initials: MB
authors.lastname: Leon
authors.affiliation: Cleveland Clinic Foundation, Cleveland, Ohio.
authors.forename: E Murat
authors.initials: EM
authors.lastname: Tuzcu
authors.affiliation: Cedars-Sinai Medical Center, Los Angeles, CA.
authors.forename: Raj
authors.initials: R
authors.lastname: Makkar
authors.affiliation: Cleveland Clinic Foundation, Cleveland, Ohio.
authors.forename: Lars G
authors.initials: LG
authors.lastname: Svensson
authors.affiliation: Stanford University, Stanford, Calif.
authors.forename: D Craig
authors.initials: DC
authors.lastname: Miller
authors.affiliation: Columbia University Medical Center/New York Presbyterian Hospital, New York, NY.
authors.forename: Craig R
authors.initials: CR
authors.lastname: Smith
authors.affiliation: Medstar Washington Hospital Center, Washington, DC.
authors.forename: Augusto D
authors.initials: AD
authors.lastname: Pichard
authors.affiliation: Hospital of the University of Pennsylvania, Philadelphia, Pa.
authors.forename: Howard C
authors.initials: HC
authors.lastname: Herrmann
authors.affiliation: Emory University School of Medicine, Atlanta, Ga.
authors.forename: Vinod H
authors.initials: VH
authors.lastname: Thourani
authors.affiliation: Hospital of the University of Pennsylvania, Philadelphia, Pa.
authors.forename: Wilson Y
authors.initials: WY
authors.lastname: Szeto
authors.affiliation: University of Virginia, Charlottesville, Va.
authors.forename: Scott
authors.initials: S
authors.lastname: Lim
authors.affiliation: Stanford University, Stanford, Calif.
authors.forename: Michael
authors.initials: M
authors.lastname: Fischbein
authors.affiliation: Stanford University, Stanford, Calif.
authors.forename: William F
authors.initials: WF
authors.lastname: Fearon
authors.affiliation: Center for Structural Heart Disease, Henry Ford Healthcare System, Detroit, Mich.
authors.forename: William
authors.initials: W
authors.lastname: O'Neill
authors.affiliation: Columbia University Medical Center/New York Presbyterian Hospital, New York, NY.
authors.forename: Ke
authors.initials: K
authors.lastname: Xu
authors.affiliation: Baylor Healthcare System, Dallas, Tex.
authors.forename: Todd
authors.initials: T
authors.lastname: Dewey
authors.affiliation: Baylor Healthcare System, Dallas, Tex.
authors.forename: Michael
authors.initials: M
authors.lastname: Mack
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001024:Aortic Valve Stenosis / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D006328:Cardiac Catheterization / Q000009:adverse effects / Q000401:mortality; D016009:Chi-Square Distribution; D003661:Decision Support Techniques; D005260:Female; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D017052:Hospital Mortality; D006801:Humans; D016015:Logistic Models; D008297:Male; D010043:Outcome and Process Assessment, Health Care; D018579:Patient Selection; D012042:Registries; D018570:Risk Assessment; D012307:Risk Factors; D012955:Societies, Medical; D013997:Time Factors; D016896:Treatment Outcome