A simple risk tool (the OBSERVANT score) for prediction of 30-day mortality after transcatheter aortic valve replacement.
Risk stratification tools used in patients with severe aortic stenosis have been mostly derived from surgical series. Although specific predictors of early mortality with transcatheter aortic valve replacement (TAVR) have been identified, the prognostic impact of their combination is unexplored. We sought to develop a simple score, using preprocedural variables, for prediction of 30-day mortality after TAVR. A total of 1,878 patients from a national multicenter registry who underwent TAVR were randomly assigned in a 2:1 manner to development and validation data sets. Baseline characteristics of the 1,256 patients in the development data set were considered as candidate univariate predictors of 30-day mortality. A bootstrap multivariate logistic regression process was used to select correlates of 30-day mortality that were subsequently weighted and integrated into a scoring system. Seven variables were weighted proportionally to their respective odds ratios for 30-day mortality (glomerular filtration rate <45 ml/min [6 points], critical preoperative state [5 points], New York Heart Association class IV [4 points], pulmonary hypertension [4 points], diabetes mellitus [4 points], previous balloon aortic valvuloplasty [3 points], and left ventricular ejection fraction <40% [3 points]). The model showed good discrimination in both the development and validation data sets (C statistics 0.73 and 0.71, respectively). Compared with the logistic European System for Cardiac Operative Risk Evaluation in the validation data set, the model showed better discrimination (C statistic 0.71 vs 0.66), goodness of fit (Hosmer-Lemeshow p value 0.81 vs 0.00), and global accuracy (Brier score 0.054 vs 0.073). In conclusion, the risk of 30-day mortality after TAVR may be estimated by combining 7 baseline clinical variables into a simple risk scoring system.
Division of Cardiology, Ferrarotto Hospital, University of Catania, Catania, Italy; ETNA Foundation, Catania, Italy. Electronic address: dcapodanno@gmail.com.
Davide
D
Capodanno
Division of Cardiology, Ferrarotto Hospital, University of Catania, Catania, Italy; ETNA Foundation, Catania, Italy.
Marco
M
Barbanti
Division of Cardiology, Ferrarotto Hospital, University of Catania, Catania, Italy; ETNA Foundation, Catania, Italy.
Corrado
C
Tamburino
National Centre for Epidemiology, Surveillance and Health Promotion, Istituto Superiore di Sanità, Rome, Italy.
Paola
P
D'Errigo
Department of Cardiothoracic and Vascular Anesthesia, Intensive Care Unit, IRCCS Policlinico San Donato, Milan, Italy; Department of Cardiac Surgery, IRCCS Policlinico San Donato, Milan, Italy.
Marco
M
Ranucci
Division of Cardiology, Careggi Hospital, Florence, Italy.
Gennaro
G
Santoro
Division of Cardiac Surgery, University of Verona Medical School, Verona, Italy.
Francesco
F
Santini
Division of Cardiac Surgery, University of Verona Medical School, Verona, Italy.
Francesco
F
Onorati
Department of Cardiovascular Surgery, S. Croce e Carle Hospital, Cuneo, Italy.
Claudio
C
Grossi
IRCCS Department of Anesthesia and Intensive Care, San Raffaele Hospital, Milan, Italy.
Remo Daniel
RD
Covello
Division of Cardiology, Ferrarotto Hospital, University of Catania, Catania, Italy; ETNA Foundation, Catania, Italy.
Piera
P
Capranzano
National Centre for Epidemiology, Surveillance and Health Promotion, Istituto Superiore di Sanità, Rome, Italy.
Stefano
S
Rosato
National Centre for Epidemiology, Surveillance and Health Promotion, Istituto Superiore di Sanità, Rome, Italy.
Fulvia
F
Seccareccia
D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D008297:Male; D001024:Aortic Valve Stenosis / Q000401:mortality / Q000503:physiopathology / Q000601:surgery; D006328:Cardiac Catheterization; D002423:Cause of Death / Q000639:trends; D015150:Echocardiography, Doppler; D005500:Follow-Up Studies; D019918:Heart Valve Prosthesis Implantation / Q000379:methods; D016017:Odds Ratio; D011184:Postoperative Period; D011379:Prognosis; D011446:Prospective Studies; D012042:Registries; D018570:Risk Assessment / Q000379:methods; D012307:Risk Factors; D012720:Severity of Illness Index; D013318:Stroke Volume; D015996:Survival Rate / Q000639:trends; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology; D016277:Ventricular Function, Left