title: Usefulness and validation of the survival posT TAVI score for survival after transcatheter aortic valve implantation for aortic stenosis.
abstract: Surgical risk scores fail to accurately predict mortality after transcatheter aortic valve implantation (TAVI). The aim of this study was to develop and validate a dedicated risk score for accurate estimation of mortality risk in these patients. All consecutive patients who underwent TAVI at 6 international institutions were enrolled. Predictors for 1-year all-cause mortality were identified by means of Cox multivariate analysis and incorporated in a prediction score. Accuracy of the score was derived and externally validated for 30-day and 1-year mortality. The net classification improvement compared with the Society of Thoracic Surgeons (STS) score was appraised. A total of 1,064 patients constituted the derivation cohort and 180 patients constituted the external validation cohort. A total of 165 patients (15%) died at 1-year follow-up. Previous stroke (odds ratio [OR] 1.80, 1.4 to 3), inverse of renal clearance (OR 8, 6 to 14), and systolic pulmonary arterial pressure ≥50 mm Hg (OR 2.10, 1.5 to 3) were independently related to 1-year mortality. Area under the curve (AUC) of the survival post TAVI (STT) for 1-year mortality was 0.68 (0.62 to 0.71). At 30 days, 65 patients (7%) had died and the AUC for the STT at this time point was 0.66 (0.64 to 0.75). In the external validation cohorts, the AUC of the STT were 0.66 (0.56 to 0.7) for 30-day and 0.67 (0.62 to 0.71) for 1-year mortality. Net reclassification improvement for STT compared with STS was 31% (p <0.001) for 30-day mortality and 14% (p <0.001) for 1-year mortality. In conclusion, the STT score represents an easy and accurate tool to assess the risk of short-term and mid-term mortality in patients undergoing TAVI.
authors.affiliation: Division of Cardiology, Città Della Salute e della Scienza Hospital, University of Turin, Turin, Italy. Electronic address: fabrizio.dascenzo@gmail.com.
authors.forename: Fabrizio
authors.initials: F
authors.lastname: D'Ascenzo
authors.affiliation: Department of Cardiology, Ferrarotto Hospital, University of Catania, Catania, Italy.
authors.forename: Davide
authors.initials: D
authors.lastname: Capodanno
authors.affiliation: Division of Cardiology, Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, Padova, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Tarantini
authors.affiliation: Department of Cardiology, University Medical Center Utrecht, Utrecht, Netherlands.
authors.forename: Freek
authors.initials: F
authors.lastname: Nijhoff
authors.affiliation: Division of Cardiology, Policlinico S. Orsola-Malpighi, Bologna, Italy.
authors.forename: Cristina
authors.initials: C
authors.lastname: Ciuca
authors.affiliation: Division of Cardiology, Istituto Humanitas, Milan, Italy.
authors.forename: Marco Luciano
authors.initials: ML
authors.lastname: Rossi
authors.affiliation: Department of Cardiology, Clinical Institute S. Ambrogio, Milan, Italy.
authors.forename: Nedy
authors.initials: N
authors.lastname: Brambilla
authors.affiliation: Department of Cardiology, Ferrarotto Hospital, University of Catania, Catania, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Barbanti
authors.affiliation: Division of Cardiology, Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, Padova, Italy.
authors.forename: Massimo
authors.initials: M
authors.lastname: Napodano
authors.affiliation: Department of Cardiology, University Medical Center Utrecht, Utrecht, Netherlands; Division of Cardiology 2, Città della Salute e della Scienza Hospital, Turin, Italy.
authors.forename: Pieter
authors.initials: P
authors.lastname: Stella
authors.affiliation: Division of Cardiology, Policlinico S. Orsola-Malpighi, Bologna, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Saia
authors.affiliation: Department of Interventional Cardiology, Istituto Clinico Humanitas (Istituto di Ricovero e Cura a Carattere Scientifico), Rozzano, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Ferrante
authors.affiliation: Department of Cardiology, Ferrarotto Hospital, University of Catania, Catania, Italy.
authors.forename: Corrado
authors.initials: C
authors.lastname: Tamburino
authors.affiliation: Division of Cardiology, Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, Padova, Italy.
authors.forename: Valeria
authors.initials: V
authors.lastname: Gasparetto
authors.affiliation: Department of Cardiology, University Medical Center Utrecht, Utrecht, Netherlands.
authors.forename: Pierfrancesco
authors.initials: P
authors.lastname: Agostoni
authors.affiliation: Division of Cardiology, Policlinico S. Orsola-Malpighi, Bologna, Italy.
authors.forename: Antonio
authors.initials: A
authors.lastname: Marzocchi
authors.affiliation: Division of Cardiology, Istituto Humanitas, Milan, Italy.
authors.forename: Patrizia
authors.initials: P
authors.lastname: Presbitero
authors.affiliation: Department of Cardiology, Clinical Institute S. Ambrogio, Milan, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Bedogni
authors.affiliation: Division of Cardiology, Città Della Salute e della Scienza Hospital, University of Turin, Turin, Italy.
authors.forename: Enrico
authors.initials: E
authors.lastname: Cerrato
authors.affiliation: Division of Cardiology, Città Della Salute e della Scienza Hospital, University of Turin, Turin, Italy.
authors.forename: Pierluigi
authors.initials: P
authors.lastname: Omedè
authors.affiliation: Division of Cardiology 2, Città della Salute e della Scienza Hospital, Turin, Italy.
authors.forename: Federico
authors.initials: F
authors.lastname: Conrotto
authors.affiliation: Division of Cardiac Surgery, Città Della Salute e della Scienza Hospital, University of Turin, Turin, Italy.
authors.forename: Stefano
authors.initials: S
authors.lastname: Salizzoni
authors.affiliation: Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Biondi Zoccai
authors.affiliation: Division of Cardiology 2, Città della Salute e della Scienza Hospital, Turin, Italy.
authors.forename: Sebastiano
authors.initials: S
authors.lastname: Marra
authors.affiliation: Division of Cardiac Surgery, Città Della Salute e della Scienza Hospital, University of Turin, Turin, Italy.
authors.forename: Mauro
authors.initials: M
authors.lastname: Rinaldi
authors.affiliation: Division of Cardiology, Città Della Salute e della Scienza Hospital, University of Turin, Turin, Italy.
authors.forename: Fiorenzo
authors.initials: F
authors.lastname: Gaita
authors.affiliation: Division of Cardiology 2, Città della Salute e della Scienza Hospital, Turin, Italy.
authors.forename: Maurizio
authors.initials: M
authors.lastname: D'Amico
authors.affiliation: Division of Cardiology, Città Della Salute e della Scienza Hospital, University of Turin, Turin, Italy; Division of Cardiology 2, Città della Salute e della Scienza Hospital, Turin, Italy.
authors.forename: Claudio
authors.initials: C
authors.lastname: Moretti
mesh_terms: D000369:Aged, 80 and over; D001024:Aortic Valve Stenosis / Q000401:mortality / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D007558:Italy / Q000453:epidemiology; D008297:Male; D016017:Odds Ratio; D011183:Postoperative Complications / Q000453:epidemiology*; D015203:Reproducibility of Results; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D015996:Survival Rate / Q000639:trends; D013997:Time Factors; D065467:Transcatheter Aortic Valve Replacement / Q000009:adverse effects*; D016896:Treatment Outcome