title: Value of the "TAVI2-SCORe" versus surgical risk scores for prediction of one year mortality in 511 patients who underwent transcatheter aortic valve implantation.
abstract: A bedside-available transcatheter aortic valve implantation (TAVI)-dedicated prognostic risk score is an unmet clinical need. We aimed to develop such a risk score predicting 1-year mortality post-TAVI and to compare it with the performance of the logistic EuroSCORE (LES) I and LES-II and the Society of Thoracic Surgeons' (STS) score. Baseline variables of 511 consecutive patients who underwent TAVI that were independently associated with 1-year mortality post-TAVI were included in the "TAVI2-SCORe." Discrimination and calibration abilities of the novel score were assessed and compared with surgical risk scores. One-year mortality was 17.0% (n = 80 of 471). Porcelain thoracic aorta (hazard ratio [HR] 2.56), anemia (HR 2.03), left ventricular dysfunction (HR 1.98), recent myocardial infarction (HR 3.78), male sex (HR 1.81), critical aortic valve stenosis (HR 2.46), old age (HR 1.68), and renal dysfunction (HR 1.76) formed the TAVI2-SCORe (all p <0.05). According to the number of points assigned (1 for each variable and 2 for infarction), patients were stratified into 5 risk categories: 0, 1 (HR 2.6), 2 (HR 3.6), 3 (HR 10.5), and ≥4 (HR 17.6). TAVI2-SCORe showed better discrimination ability (Harrells' C statistic 0.715) compared with LES-I, LES-II, and STS score (0.609, 0.633, and 0.50, respectively). Cumulative 1-year survival rate was 54% versus 88% for patients with TAVI2-SCORE ≥3 versus <3 points, respectively (p <0.001). Contrary to surgical risk scores, there was no significant difference between observed and expected 1-year mortality for all TAVI2-SCORe risk strata (all p >0.05, Hosmer-Lemeshow statistic 0.304), suggesting superior calibration performance. In conclusion, the TAVI2-SCORe is an accurate, simple, and bedside-available score predicting 1-year mortality post-TAVI, outperforming conventional surgical risk scores for this end point.
authors.affiliation: Cardiology Department, Leiden University Medical Center, Leiden, The Netherlands; Cardiology Department, Sint-Jan Hospital, Bruges, Belgium.
authors.forename: Philippe
authors.initials: P
authors.lastname: Debonnaire
authors.affiliation: Centro Cardiologico Monzino IRCCS, Milan, Italy.
authors.forename: Laura
authors.initials: L
authors.lastname: Fusini
authors.affiliation: Medical Statistics Department, Leiden University Medical Center, Leiden, The Netherlands.
authors.forename: Ron
authors.initials: R
authors.lastname: Wolterbeek
authors.affiliation: Cardiology Department, Leiden University Medical Center, Leiden, The Netherlands.
authors.forename: Vasileios
authors.initials: V
authors.lastname: Kamperidis
authors.affiliation: Cardiology Department, Leiden University Medical Center, Leiden, The Netherlands.
authors.forename: Philippe
authors.initials: P
authors.lastname: van Rosendael
authors.affiliation: Cardiology Department, Leiden University Medical Center, Leiden, The Netherlands.
authors.forename: Frank
authors.initials: F
authors.lastname: van der Kley
authors.affiliation: Cardiology Department, Leiden University Medical Center, Leiden, The Netherlands.
authors.forename: Spyridon
authors.initials: S
authors.lastname: Katsanos
authors.affiliation: Cardiology Department, Leiden University Medical Center, Leiden, The Netherlands.
authors.forename: Emer
authors.initials: E
authors.lastname: Joyce
authors.affiliation: Centro Cardiologico Monzino IRCCS, Milan, Italy.
authors.forename: Gloria
authors.initials: G
authors.lastname: Tamborini
authors.affiliation: Centro Cardiologico Monzino IRCCS, Milan, Italy.
authors.forename: Manuela
authors.initials: M
authors.lastname: Muratori
authors.affiliation: Centro Cardiologico Monzino IRCCS, Milan, Italy.
authors.forename: Paola
authors.initials: P
authors.lastname: Gripari
authors.affiliation: Cardiology Department, Leiden University Medical Center, Leiden, The Netherlands.
authors.forename: Jeroen J
authors.initials: JJ
authors.lastname: Bax
authors.affiliation: Cardiology Department, Leiden University Medical Center, Leiden, The Netherlands.
authors.forename: Nina Ajmone
authors.initials: NA
authors.lastname: Marsan
authors.affiliation: Centro Cardiologico Monzino IRCCS, Milan, Italy.
authors.forename: Mauro
authors.initials: M
authors.lastname: Pepi
authors.affiliation: Cardiology Department, Leiden University Medical Center, Leiden, The Netherlands. Electronic address: v.delgado@lumc.nl.
authors.forename: Victoria
authors.initials: V
authors.lastname: Delgado
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001024:Aortic Valve Stenosis / Q000401:mortality / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007558:Italy / Q000453:epidemiology; D008297:Male; D009426:Netherlands / Q000453:epidemiology; D011183:Postoperative Complications / Q000401:mortality*; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D015996:Survival Rate / Q000639:trends; D013997:Time Factors; D065467:Transcatheter Aortic Valve Replacement