title: Meta-analysis on the performance of the EuroSCORE II and the Society of Thoracic Surgeons Scores in patients undergoing aortic valve replacement.
abstract: OBJECTIVE
  To evaluate the performance of the EuroSCORE II (ESII) and the Society of Thoracic Surgeons (STS) scores in surgical (SAVR) or transcatheter aortic valve replacement (TAVR).
  
  
  METHODS
  Systematic review of the literature and meta-analysis.
  
  
  METHODS
  University hospitals.
  
  
  METHODS
  Studies reporting data on the performance of ESII and STS scores in patients undergoing SAVR or TAVR.
  
  
  METHODS
  SAVR or TAVR.
  
  
  RESULTS
  Ten studies validated these scores in 13,856 patients who underwent either TAVR or SAVR. Operative mortality was 5.9% (SAVR 3.1%; TAVR 9.6%). ESII-expected mortality was 5.1% (O/E ratio: 1.15, SAVR, O/E ratio 0.94; TAVR, O/E ratio 1.23) and STS-expected mortality was 6.3% (O/E ratio: 0.94, SAVR, O/E ratio 0.84; TAVR, O/E ratio 1.13). The area under the ROC curve for ESII was 0.70 and for STS was 0.70 (SAVR patients: 0.73 for ESII and 0.75 for STS; TAVR patients; 0.66 for ESII and 0.63 for STS). The difference between observed/expected mortality was not significant for ESII (Peto's OR 0.99, p = 0.88) and was significant for STS (Peto's OR 0.86, p = 0.008). ESII (Peto's OR 1.35, p<0.00001) and STS (Peto's OR 1.23, p<0.00001) significantly underestimated the mortality risk in TAVR patients. The STS (Peto's OR 0.74, p<0.0001) and, to a lesser extent, the ESII (Peto's OR 0.86, p = 0.0.04) overestimated the mortality risk in SAVR patients.
  
  
  CONCLUSIONS
  The ESII and STS scores have good O/E ratios for either TAVR or SAVR patients, but both scores significantly underpredicted the risk of TAVR patients. ESII seemed to be accurate in predicting the risk of SAVR patients.
authors.affiliation: Department of Surgery, Oulu University Hospital, Oulu, Finland. Electronic address: faustobiancari@yahoo.it.
authors.forename: Fausto
authors.initials: F
authors.lastname: Biancari
authors.affiliation: Department of Surgery, Oulu University Hospital, Oulu, Finland.
authors.forename: Tatu
authors.initials: T
authors.lastname: Juvonen
authors.affiliation: Division of Cardiac Surgery, University of Verona Medical School, Verona, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Onorati
authors.affiliation: Division of Cardiac Surgery, University of Verona Medical School, Verona, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Faggian
authors.affiliation: Department of Surgery, Oulu University Hospital, Oulu, Finland.
authors.forename: Jouni
authors.initials: J
authors.lastname: Heikkinen
authors.affiliation: Heart Center, Turku University Hospital, Turku, Finland.
authors.forename: Juhani
authors.initials: J
authors.lastname: Airaksinen
authors.affiliation: Cardiac Surgery Unit, Varese University Hospital, Varese, Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Mariscalco
mesh_terms: D001021:Aortic Valve / Q000601:surgery; D019918:Heart Valve Prosthesis Implantation / Q000401:mortality*; D017052:Hospital Mortality; D006801:Humans; D012372:ROC Curve; D015203:Reproducibility of Results; D018570:Risk Assessment / Q000379:methods / Q000592:standards; D012720:Severity of Illness Index; D012955:Societies, Medical; D066231:Surgeons; D065467:Transcatheter Aortic Valve Replacement / Q000401:mortality; D016896:Treatment Outcome
keywords: EuroSCORE II; STS score; aortic valve; meta-analysis; replacement; statistics