title: Performance of surgical risk scores to predict mortality after transcatheter aortic valve implantation.
abstract: Predicting mortality in patients undergoing transcatheter aortic valve implantation (TAVI) remains a challenge.
  
  
  
  To evaluate the performance of 5 risk scores for cardiac surgery in predicting the 30-day mortality among patients of the Brazilian Registry of TAVI.
  
  
  
  The Brazilian Multicenter Registry prospectively enrolled 418 patients undergoing TAVI in 18 centers between 2008 and 2013. The 30-day mortality risk was calculated using the following surgical scores: the logistic EuroSCORE I (ESI), EuroSCORE II (ESII), Society of Thoracic Surgeons (STS) score, Ambler score (AS) and Guaragna score (GS). The performance of the risk scores was evaluated in terms of their calibration (Hosmer-Lemeshow test) and discrimination [area under the receiver-operating characteristic curve (AUC)].
  
  
  
  The mean age was 81.5 ± 7.7 years. The CoreValve (Medtronic) was used in 86.1% of the cohort, and the transfemoral approach was used in 96.2%. The observed 30-day mortality was 9.1%. The 30-day mortality predicted by the scores was as follows: ESI, 20.2 ± 13.8%; ESII, 6.5 ± 13.8%; STS score, 14.7 ± 4.4%; AS, 7.0 ± 3.8%; GS, 17.3 ± 10.8%. Using AUC, none of the tested scores could accurately predict the 30-day mortality. AUC for the scores was as follows: 0.58 [95% confidence interval (CI): 0.49 to 0.68, p = 0.09] for ESI; 0.54 (95% CI: 0.44 to 0.64, p = 0.42) for ESII; 0.57 (95% CI: 0.47 to 0.67, p = 0.16) for AS; 0.48 (95% IC: 0.38 to 0.57, p = 0.68) for STS score; and 0.52 (95% CI: 0.42 to 0.62, p = 0.64) for GS. The Hosmer-Lemeshow test indicated acceptable calibration for all scores (p > 0.05).
  
  
  
  In this real world Brazilian registry, the surgical risk scores were inaccurate in predicting mortality after TAVI. Risk models specifically developed for TAVI are required.
authors.affiliation: Pontifícia Universidade Católica, Porto Alegre, BR.
authors.forename: Leonardo Sinnott
authors.initials: LS
authors.lastname: Silva
authors.affiliation: Pontifícia Universidade Católica, Porto Alegre, BR.
authors.forename: Paulo Ricardo Avancini
authors.initials: PR
authors.lastname: Caramori
authors.affiliation: Hospital Israelita Albert Einstein, São Paulo, BR.
authors.forename: Antonio Carlos Bacelar
authors.initials: AC
authors.lastname: Nunes Filho
authors.affiliation: Hospital Israelita Albert Einstein, São Paulo, BR.
authors.forename: Marcelo
authors.initials: M
authors.lastname: Katz
authors.affiliation: Pontifícia Universidade Católica, Porto Alegre, BR.
authors.forename: João Carlos Vieira da Costa
authors.initials: JC
authors.lastname: Guaragna
authors.affiliation: Instituto do Coração, São Paulo, BR.
authors.forename: Pedro
authors.initials: P
authors.lastname: Lemos
authors.affiliation: Hospital Santa Casa de Misericórdia, Porto Alegre, BR.
authors.forename: Valter
authors.initials: V
authors.lastname: Lima
authors.affiliation: Instituto Dante Pazzanese de Cardiologia, São Paulo, BR.
authors.forename: Alexandre
authors.initials: A
authors.lastname: Abizaid
authors.affiliation: Hospital Israelita Albert Einstein, São Paulo, BR.
authors.forename: Flavio
authors.initials: F
authors.lastname: Tarasoutchi
authors.affiliation: Hospital Israelita Albert Einstein, São Paulo, BR.
authors.forename: Fabio S de
authors.initials: FS
authors.lastname: Brito
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001024:Aortic Valve Stenosis / Q000401:mortality / Q000601:surgery; D001938:Brazil; D002138:Calibration; D004812:Epidemiologic Methods; D005260:Female; D006801:Humans; D008297:Male; D012016:Reference Values; D015203:Reproducibility of Results; D018570:Risk Assessment / Q000379:methods*; D013997:Time Factors; D065467:Transcatheter Aortic Valve Replacement / Q000401:mortality*