Relationship between the logistic EuroSCORE and the Society of Thoracic Surgeons Predicted Risk of Mortality score in patients implanted with the CoreValve ReValving System—A Bern-Rotterdam Study

• Published in: The American heart journal Vol. 159; no. 2; pp. 323 - 329
• Main Authors: Piazza, Nicolo, MD, FRCPC, Wenaweser, Peter, MD, PhD, van Gameren, Menno, MD, Pilgrim, Thomas, MD, Tsikas, Apostolos, MD, Otten, Amber, MD, Nuis, Rutger, MD, Onuma, Yoshinobu, MD, Cheng, Jin Ming, MD, Kappetein, A. Pieter, MD, PhD, Boersma, Eric, MD, PhD, Juni, Peter, MD, PhD, de Jaegere, Peter, MD, PhD, Windecker, Stephan, MD, PhD, Serruys, Patrick W., MD, PhD
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01-02-2010; Mosby; Elsevier Limited
• Subjects: Aged, 80 and over; Algorithms; Aortic Valve - surgery; Biological and medical sciences; Bioprosthesis; Calibration; Cardiology; Cardiology. Vascular system; Cardiovascular; Cardiovascular disease; Chronic obstructive pulmonary disease; Decision making; Female; Heart; Heart attacks; Heart Valve Diseases - mortality; Heart Valve Diseases - surgery; Heart Valve Prosthesis; Humans; Hypertension; Male; Medical sciences; Mortality; Patients; Retrospective Studies; Risk Assessment; Risk Factors; Sepsis; Society; Software; Stroke; Variables; Europe; Human; Prognosis; Implant; Mortality; Patient; Cardiovascular disease; Risk; Thorax; Surgeon; System; Implanted; Risk factor; Circulatory system; Society; Cardiology; Predictive factor
• ISSN: 0002-8703; 1097-6744
• DOI: 10.1016/j.ahj.2009.11.026

Background Surgical risk scores, such as the logistic EuroSCORE (LES) and Society of Thoracic Surgeons Predicted Risk of Mortality (STS) score, are commonly used to identify high-risk or “inoperable” patients for transcatheter aortic valve implantation (TAVI). In Europe, the LES plays an important role in selecting patients for implantation with the Medtronic CoreValve System. What is less clear, however, is the role of the STS score of these patients and the relationship between the LES and STS. Objective The purpose of this study is to examine the correlation between LES and STS scores and their performance characteristics in high-risk surgical patients implanted with the Medtronic CoreValve System. Methods All consecutive patients (n = 168) in whom a CoreValve bioprosthesis was implanted between November 2005 and June 2009 at 2 centers (Bern University Hospital, Bern, Switzerland, and Erasmus Medical Center, Rotterdam, The Netherlands) were included for analysis. Patient demographics were recorded in a prospective database. Logistic EuroSCORE and STS scores were calculated on a prospective and retrospective basis, respectively. Results Observed mortality was 11.1%. The mean LES was 3 times higher than the mean STS score (LES 20.2% ± 13.9% vs STS 6.7% ± 5.8%). Based on the various LES and STS cutoff values used in previous and ongoing TAVI trials, 53% of patients had an LES ≥15%, 16% had an STS ≥10%, and 40% had an LES ≥20% or STS ≥10%. Pearson correlation coefficient revealed a reasonable (moderate) linear relationship between the LES and STS scores, r = 0.58, P < .001. Although the STS score outperformed the LES, both models had suboptimal discriminatory power (c-statistic, 0.49 for LES and 0.69 for STS) and calibration. Conclusions Clinical judgment and the Heart Team concept should play a key role in selecting patients for TAVI, whereas currently available surgical risk score algorithms should be used to guide clinical decision making.