title: The Society of Thoracic Surgery Risk Score as a Predictor of 30-Day Mortality in Transcatheter vs Surgical Aortic Valve Replacement: A Single-Center Experience and its Implications for the Development of a TAVR Risk-Prediction Model.
abstract: BACKGROUND
  The Society of Thoracic Surgery (STS) risk score serves as an important determinant of eligibility for transcatheter aortic valve replacement (TAVR). The STS score's validity for predicting TAVR mortality, however, is incompletely understood. This study compares the STS score's discriminatory power for TAVR mortality as compared with surgical aortic valve replacement (SAVR) mortality.
  
  
  METHODS
  A retrospective analysis of STS score and 30-day mortality for TAVR patients (n = 426) and SAVR patients (n = 297) at a single institution was performed. The performance of the STS score was evaluated from the standpoint of discriminatory power. The predictive ability of STS for 30-day mortality was detected by generation of receiver operator characteristic (ROC) curves.
  
  
  RESULTS
  The STS score possesses predictive ability for 30-day SAVR mortality with an area under the ROC curve of 0.791 (95% confidence interval [CI], 0.690-0.893). The STS score also possesses predictive ability for 30-day TAVR mortality with an area under the ROC curve of 0.674 (95% CI, 0.541-0.807). When stratifying TAVR by access route, the STS score for transfemoral TAVR provides an area under the ROC curve of 0.789 (95% CI, 0.569-1.000). There is not a statistically significant difference in predictive ability between SAVR and TAVR.
  
  
  CONCLUSIONS
  The STS score possesses predictive value for 30-day mortality in both SAVR and TAVR. Although not designed for TAVR, the STS score may provide some insight into TAVR mortality, and therefore serves as an appropriate model for efforts to develop a TAVR-specific risk prediction instrument.
authors.affiliation: Department of Internal Medicine, Division of Cardiology, The McGovern Medical School at The University of Texas Health Science Center Houston, 6431 Fannin Street, MSB 1.257, Houston, TX 77030 USA. prakash.balan@uth.tmc.edu.
authors.forename: Prakash
authors.initials: P
authors.lastname: Balan
authors.forename: Yelin
authors.initials: Y
authors.lastname: Zhao
authors.forename: Sarah
authors.initials: S
authors.lastname: Johnson
authors.forename: Salman
authors.initials: S
authors.lastname: Arain
authors.forename: Abhijeet
authors.initials: A
authors.lastname: Dhoble
authors.forename: Anthony
authors.initials: A
authors.lastname: Estrera
authors.forename: Richard
authors.initials: R
authors.lastname: Smalling
authors.forename: Tom C
authors.initials: TC
authors.lastname: Nguyen
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001024:Aortic Valve Stenosis / Q000175:diagnosis / Q000601:surgery*; D005260:Female; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects / Q000379:methods / Q000401:mortality; D006801:Humans; D008297:Male; D009026:Mortality; D056510:Position-Specific Scoring Matrices; D011237:Predictive Value of Tests; D011379:Prognosis; D012372:ROC Curve; D012107:Research Design; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D012720:Severity of Illness Index; D065467:Transcatheter Aortic Valve Replacement / Q000009:adverse effects / Q000379:methods / Q000401:mortality; D014481:United States