title: Outcome prediction following transcatheter aortic valve implantation: Multiple risk scores comparison.
abstract: BACKGROUND
  The aim of the study was to compare 7 available risk models in the prediction of 30-day mortality following transcatheter aortic valve implantation (TAVI). Heart team decision supported by different risk score calculations is advisable to estimate the individual procedural risk before TAVI.
  
  
  METHODS
  One hundred and fifty-six consecutive patients (n = 156, 48% female, mean age 80.03 ± 8.18 years) who underwent TAVI between March 2010 and October 2014 were in-cluded in the study. Thirty-day follow-up was performed and available in each patient. Base-line risk was calculated according to EuroSCORE I, EuroSCORE II, STS, ACEF, Ambler's, OBSERVANT and SURTAVI scores.
  
  
  RESULTS
  In receiver operating characteristics analysis, neither of the investigated scales was able to distinguish between patients with or without an endpoint with areas under the curve (AUC) not exceeding 0.6, as follows: EuroSCORE I, AUC 0.55; 95% confidence intervals (CI) 0.47-0.63, p = 0.59; EuroSCORE II, AUC 0.59; 95% CI 0.51-0.67, p = 0.23; STS, AUC 0.55; 95% CI 0.47-0.63, p = 0.52; ACEF, AUC 0.54; 95% CI 0.46-0.62, p = 0.69; Ambler's, AUC 0.54; 95% CI 0.46-0.62, p = 0.70; OBSERVANT, AUC 0.597; 95% CI 0.52-0.67, p = 0.21; SURTAVI, AUC 0.535; 95% CI 0.45-0.62, p = 0.65. SURTAVI model was calibrated best in high-risk patients showing coherence between expected and observed mortality (10.8% vs. 9.4%, p = 0.982). ACEF demonstrated best classification accuracy (17.5% vs. 6.9%, p = 0.053, observed mortality in high vs. non-high-risk cohort, respectively).
  
  
  CONCLUSIONS
  None of the investigated risk scales proved to be optimal in predicting 30-day mortality in unselected, real-life population with aortic stenosis referred to TAVI. This data supports primary role of heart team in decision process of selecting patients for TAVI.
authors.affiliation: 1st Department of Cardiology, Medical University of Warsaw, Poland. karol.zbronski@gmail.com.
authors.forename: Karol
authors.initials: K
authors.lastname: Zbroński
authors.forename: Zenon
authors.initials: Z
authors.lastname: Huczek
authors.forename: Dominika
authors.initials: D
authors.lastname: Puchta
authors.forename: Katarzyna
authors.initials: K
authors.lastname: Paczwa
authors.forename: Janusz
authors.initials: J
authors.lastname: Kochman
authors.forename: Radosław
authors.initials: R
authors.lastname: Wilimski
authors.forename: Piotr
authors.initials: P
authors.lastname: Scisło
authors.forename: Bartosz
authors.initials: B
authors.lastname: Rymuza
authors.forename: Krzysztof J
authors.initials: KJ
authors.lastname: Filipiak
authors.forename: Grzegorz
authors.initials: G
authors.lastname: Opolski
mesh_terms: D000369:Aged, 80 and over; D001021:Aortic Valve / Q000000981:diagnostic imaging / Q000601:surgery*; D001024:Aortic Valve Stenosis / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D004452:Echocardiography; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D011044:Poland / Q000453:epidemiology; D011379:Prognosis; D012372:ROC Curve; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D015996:Survival Rate / Q000639:trends; D013997:Time Factors; D065467:Transcatheter Aortic Valve Replacement / Q000379:methods*; D016896:Treatment Outcome
keywords: aortic stenosis; risk prediction; transcatheter aortic valve implantation