title: Inadequacy of existing clinical prediction models for predicting mortality after transcatheter aortic valve implantation.
abstract: The performance of emerging transcatheter aortic valve implantation (TAVI) clinical prediction models (CPMs) in national TAVI cohorts distinct from those where they have been derived is unknown. This study aimed to investigate the performance of the German Aortic Valve, FRANCE-2, OBSERVANT and American College of Cardiology (ACC) TAVI CPMs compared with the performance of historic cardiac CPMs such as the EuroSCORE and STS-PROM, in a large national TAVI registry.
  
  
  
  The calibration and discrimination of each CPM were analyzed in 6676 patients from the UK TAVI registry, as a whole cohort and across several subgroups. Strata included gender, diabetes status, access route, and valve type. Furthermore, the amount of agreement in risk classification between each of the considered CPMs was analyzed at an individual patient level.
  
  
  
  The observed 30-day mortality rate was 5.4%. In the whole cohort, the majority of CPMs over-estimated the risk of 30-day mortality, although the mean ACC score (5.2%) approximately matched the observed mortality rate. The areas under ROC curve were between 0.57 for OBSERVANT and 0.64 for ACC. Risk classification agreement was low across all models, with Fleiss's kappa values between 0.17 and 0.50.
  
  
  
  Although the FRANCE-2 and ACC models outperformed all other CPMs, the performance of current TAVI-CPMs was low when applied to an independent cohort of TAVI patients. Hence, TAVI specific CPMs need to be derived outside populations previously used for model derivation, either by adapting existing CPMs or developing new risk scores in large national registries.
authors.affiliation: Health e-Research Centre, University of Manchester, Manchester, United Kingdom.
authors.forename: Glen P
authors.initials: GP
authors.lastname: Martin
authors.affiliation: Health e-Research Centre, University of Manchester, Manchester, United Kingdom.
authors.forename: Matthew
authors.initials: M
authors.lastname: Sperrin
authors.affiliation: Queen Elizabeth Hospital, Birmingham, United Kingdom.
authors.forename: Peter F
authors.initials: PF
authors.lastname: Ludman
authors.affiliation: James Cook University Hospital, Middlesbrough, United Kingdom.
authors.forename: Mark A
authors.initials: MA
authors.lastname: de Belder
authors.affiliation: MRC Bioinformatics Unit, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds.
authors.forename: Chris P
authors.initials: CP
authors.lastname: Gale
authors.affiliation: Department of Cardiovascular Sciences, University of Leicester, Clinical Sciences Wing, Glenfield General Hospital, Leicester, United Kingdom; NIHR Leicester Cardiovascular Biomedical Research Unit, Leicester, United Kingdom.
authors.forename: William D
authors.initials: WD
authors.lastname: Toff
authors.affiliation: Royal Brompton and Harefield National Health Service (NHS) Foundation Trust, London, United Kingdom.
authors.forename: Neil E
authors.initials: NE
authors.lastname: Moat
authors.affiliation: Sussex Cardiac Centre, Brighton and Sussex University Hospitals, Brighton,United Kingdom.
authors.forename: Uday
authors.initials: U
authors.lastname: Trivedi
authors.affiliation: Health e-Research Centre, University of Manchester, Manchester, United Kingdom.
authors.forename: Iain
authors.initials: I
authors.lastname: Buchan
authors.affiliation: Health e-Research Centre, University of Manchester, Manchester, United Kingdom; Keele Cardiovascular Research Group, Keele University, Stoke-on-Trent, UK, Royal Stoke Hospital, University Hospitals North Midlands, Stoke-on-Trent, United Kingdom. Electronic address: mamasmamas1@yahoo.co.uk.
authors.forename: Mamas A
authors.initials: MA
authors.lastname: Mamas
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001024:Aortic Valve Stenosis / Q000601:surgery*; D002423:Cause of Death; D003661:Decision Support Techniques; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009026:Mortality; D012372:ROC Curve; D012042:Registries; D018570:Risk Assessment; D065467:Transcatheter Aortic Valve Replacement; D006113:United Kingdom