title: Agreement between the new EuroSCORE II, the Logistic EuroSCORE and the Society of Thoracic Surgeons score: implications for transcatheter aortic valve implantation.
abstract: BACKGROUND
  The Logistic European System for Cardiac Operative Risk Evaluation (EuroSCORE) and the Society of Thoracic Surgeons (STS) score are routinely used to identify patients at high surgical risk as potential candidates for transcatheter aortic valve implantation (TAVI).
  
  
  OBJECTIVE
  To compare the new EuroSCORE II with the Logistic EuroSCORE and the STS score.
  
  
  METHODS
  From October 2006 to June 2011, patients with severe symptomatic aortic stenosis who underwent a TAVI were enrolled prospectively.
  
  
  RESULTS
  Among 272 patients, the EuroSCORE II was significantly lower and moderately correlated with the Logistic EuroSCORE (9±8% vs. 23±14%, P<0.01; r=0.61, P<0.001), but similar to and poorly correlated with the STS (10±9%, P=0.10; r=0.25, P<0.001). Based on recommended high-risk thresholds (Logistic EuroSCORE≥20%; STS≥10%), a EuroSCORE II≥7% provided the best diagnostic value. However, using the EuroSCORE II, Logistic EuroSCORE or STS score, only 51%, 58% and 37% of patients, respectively, reached these thresholds. Contingency analyses showed that agreements between the EuroSCORE II and the Logistic EuroSCORE or the STS score were modest or poor, respectively, with a risk assessment different in 28% and 36% of patients, respectively.
  
  
  CONCLUSIONS
  A EuroSCORE II≥7% corresponded to a Logistic EuroSCORE≥20% or STS score≥10%, but correlations and agreements were at best modest and only approximately half of the patients reached these thresholds. Our results highlight the limits of current scoring systems and reinforce the European guidelines stressing the importance of clinical judgment in addition to risk scores.
authors.affiliation: Department of Cardiology, Assistance publique-Hôpitaux de Paris, Bichat Hospital, Paris, France.
authors.forename: Dimitri
authors.initials: D
authors.lastname: Arangalage
authors.affiliation: Department of Cardiology, Assistance publique-Hôpitaux de Paris, Bichat Hospital, Paris, France; University Paris 7, Faculté de Médecine Paris-Diderot, Paris, France.
authors.forename: Claire
authors.initials: C
authors.lastname: Cimadevilla
authors.affiliation: Department of Cardiac Surgery, Assistance publique-Hôpitaux de Paris, Bichat Hospital, Paris, France.
authors.forename: Soleiman
authors.initials: S
authors.lastname: Alkhoder
authors.affiliation: Department of Cardiology, Assistance publique-Hôpitaux de Paris, Bichat Hospital, Paris, France.
authors.forename: Andrea
authors.initials: A
authors.lastname: Chiampan
authors.affiliation: Department of Cardiology, Assistance publique-Hôpitaux de Paris, Bichat Hospital, Paris, France.
authors.forename: Dominique
authors.initials: D
authors.lastname: Himbert
authors.affiliation: Department of Cardiology, Assistance publique-Hôpitaux de Paris, Bichat Hospital, Paris, France.
authors.forename: Eric
authors.initials: E
authors.lastname: Brochet
authors.affiliation: Department of Cardiology, Assistance publique-Hôpitaux de Paris, Bichat Hospital, Paris, France; University Paris 7, Faculté de Médecine Paris-Diderot, Paris, France.
authors.forename: Bernard
authors.initials: B
authors.lastname: Iung
authors.affiliation: Department of Cardiac Surgery, Assistance publique-Hôpitaux de Paris, Bichat Hospital, Paris, France.
authors.forename: Patrick
authors.initials: P
authors.lastname: Nataf
authors.affiliation: Department of Anesthesiology, Assistance publique-Hôpitaux de Paris, Bichat Hospital, Paris, France.
authors.forename: Jean-Pol
authors.initials: JP
authors.lastname: Depoix
authors.affiliation: Department of Cardiology, Assistance publique-Hôpitaux de Paris, Bichat Hospital, Paris, France; University Paris 7, Faculté de Médecine Paris-Diderot, Paris, France.
authors.forename: Alec
authors.initials: A
authors.lastname: Vahanian
authors.affiliation: Department of Cardiology, Assistance publique-Hôpitaux de Paris, Bichat Hospital, Paris, France; University Paris 7, Faculté de Médecine Paris-Diderot, Paris, France; INSERM U1148, Bichat Hospital, Paris, France. Electronic address: david.messika-zeitoun@bch.aphp.fr.
authors.forename: David
authors.initials: D
authors.lastname: Messika-Zeitoun
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001024:Aortic Valve Stenosis / Q000150:complications / Q000175:diagnosis / Q000628:therapy*; D006328:Cardiac Catheterization / Q000009:adverse effects* / Q000295:instrumentation; D003661:Decision Support Techniques; D005260:Female; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects* / Q000295:instrumentation / Q000379:methods; D006801:Humans; D016014:Linear Models; D016015:Logistic Models; D008297:Male; D018579:Patient Selection; D011237:Predictive Value of Tests; D011446:Prospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index
keywords: Aortic valve stenosis; Remplacement valvulaire aortique percutané; Risk assessment; Sténose aortique; Transcatheter aortic valve implantation; Évaluation du risque