title: Performance of contemporary surgical risk scores for transcatheter aortic valve implantation: A meta-analysis.
abstract: BACKGROUND
  Transcatheter aortic valve implantation (TAVI) is considered for severe aortic valve disease at high and now intermediate risk for surgical aortic valve replacement. Risk stratification plays a critical role decision-making for intervention and modality. We compared the prognostic utility of surgical risk scores for TAVI in this meta-analysis.
  
  
  METHODS
  MEDLINE, Embase, Cochrane and Web of Science databases from 1 January 1980 to 31 December 2015 were searched. Studies were systematically reviewed for inclusion, and data extracted for pooled analyses.
  
  
  RESULTS
  Amongst 1688 articles searched, 47 full-text articles were screened and 24 studies (12,346 TAVI cases) included for analyses. Pooled c-statistics (95% confidence interval) for operative mortality were EuroSCORE 0.62 (0.57-0.67), EuroSCORE II 0.62 (0.59-0.66), STS Score 0.62 (0.59-0.65). Pooled calibration odds ratios (95%CI) were EuroSCORE 0.31 (0.25-0.38), EuroSCORE II 1.26 (1.06-1.51), STS 0.95 (0.72-1.27). C-statistics (95%CI) for 1-year mortality were EuroSCORE 0.62 (0.57-0.67), EuroSCORE II 0.66 (0.61-0.71) and STS Score 0.58 (0.53-0.64).
  
  
  CONCLUSIONS
  Surgical risk scores at most modestly discriminated operative and 1-year mortality. The EuroSCORE grossly over-estimated operative mortality while the EuroSCORE II and STS Scores fitted better to TAVI outcomes with their own limitations. There is a need for the development and validation of TAVI-specific risk models.
authors.affiliation: Green Lane Cardiovascular Service, Auckland City Hospital, Auckland, New Zealand; Department of Medicine, University of Auckland, Auckland, New Zealand. Electronic address: TWang@adhb.govt.nz.
authors.forename: Tom Kai Ming
authors.initials: TKM
authors.lastname: Wang
authors.affiliation: Department of Medicine, University of Auckland, Auckland, New Zealand.
authors.forename: Michael Tzu Min
authors.initials: MTM
authors.lastname: Wang
authors.affiliation: Department of Medicine, University of Auckland, Auckland, New Zealand.
authors.forename: Greg D
authors.initials: GD
authors.lastname: Gamble
authors.affiliation: Green Lane Cardiovascular Service, Auckland City Hospital, Auckland, New Zealand.
authors.forename: Mark
authors.initials: M
authors.lastname: Webster
authors.affiliation: Green Lane Cardiovascular Service, Auckland City Hospital, Auckland, New Zealand; Department of Medicine, University of Auckland, Auckland, New Zealand.
authors.forename: Peter N
authors.initials: PN
authors.lastname: Ruygrok
mesh_terms: D001024:Aortic Valve Stenosis / Q000175:diagnosis* / Q000401:mortality / Q000601:surgery*; D006801:Humans; D064887:Observational Studies as Topic; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D065467:Transcatheter Aortic Valve Replacement / Q000401:mortality
keywords: Aortic stenosis; Risk modelling; Transcatheter aortic valve implantation