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Performance of Surgical Risk Scores to Predict Mortality after Transcatheter Aortic Valve Implantation

BACKGROUND: Predicting mortality in patients undergoing transcatheter aortic valve implantation (TAVI) remains a challenge. OBJECTIVES: To evaluate the performance of 5 risk scores for cardiac surgery in predicting the 30-day mortality among patients of the Brazilian Registry of TAVI. METHODS: The B...

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Autores principales: Silva, Leonardo Sinnott, Caramori, Paulo Ricardo Avancini, Nunes Filho, Antonio Carlos Bacelar, Katz, Marcelo, Guaragna, João Carlos Vieira da Costa, Lemos, Pedro, Lima, Valter, Abizaid, Alexandre, Tarasoutchi, Flavio, de Brito Jr, Fabio S.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Sociedade Brasileira de Cardiologia 2015
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4592172/
https://www.ncbi.nlm.nih.gov/pubmed/26247244
http://dx.doi.org/10.5935/abc.20150084
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author Silva, Leonardo Sinnott
Caramori, Paulo Ricardo Avancini
Nunes Filho, Antonio Carlos Bacelar
Katz, Marcelo
Guaragna, João Carlos Vieira da Costa
Lemos, Pedro
Lima, Valter
Abizaid, Alexandre
Tarasoutchi, Flavio
de Brito Jr, Fabio S.
author_facet Silva, Leonardo Sinnott
Caramori, Paulo Ricardo Avancini
Nunes Filho, Antonio Carlos Bacelar
Katz, Marcelo
Guaragna, João Carlos Vieira da Costa
Lemos, Pedro
Lima, Valter
Abizaid, Alexandre
Tarasoutchi, Flavio
de Brito Jr, Fabio S.
author_sort Silva, Leonardo Sinnott
collection PubMed
description BACKGROUND: Predicting mortality in patients undergoing transcatheter aortic valve implantation (TAVI) remains a challenge. OBJECTIVES: To evaluate the performance of 5 risk scores for cardiac surgery in predicting the 30-day mortality among patients of the Brazilian Registry of TAVI. METHODS: The Brazilian Multicenter Registry prospectively enrolled 418 patients undergoing TAVI in 18 centers between 2008 and 2013. The 30-day mortality risk was calculated using the following surgical scores: the logistic EuroSCORE I (ESI), EuroSCORE II (ESII), Society of Thoracic Surgeons (STS) score, Ambler score (AS) and Guaragna score (GS). The performance of the risk scores was evaluated in terms of their calibration (Hosmer–Lemeshow test) and discrimination [area under the receiver–operating characteristic curve (AUC)]. RESULTS: The mean age was 81.5 ± 7.7 years. The CoreValve (Medtronic) was used in 86.1% of the cohort, and the transfemoral approach was used in 96.2%. The observed 30-day mortality was 9.1%. The 30-day mortality predicted by the scores was as follows: ESI, 20.2 ± 13.8%; ESII, 6.5 ± 13.8%; STS score, 14.7 ± 4.4%; AS, 7.0 ± 3.8%; GS, 17.3 ± 10.8%. Using AUC, none of the tested scores could accurately predict the 30-day mortality. AUC for the scores was as follows: 0.58 [95% confidence interval (CI): 0.49 to 0.68, p = 0.09] for ESI; 0.54 (95% CI: 0.44 to 0.64, p = 0.42) for ESII; 0.57 (95% CI: 0.47 to 0.67, p = 0.16) for AS; 0.48 (95% IC: 0.38 to 0.57, p = 0.68) for STS score; and 0.52 (95% CI: 0.42 to 0.62, p = 0.64) for GS. The Hosmer–Lemeshow test indicated acceptable calibration for all scores (p > 0.05). CONCLUSIONS: In this real world Brazilian registry, the surgical risk scores were inaccurate in predicting mortality after TAVI. Risk models specifically developed for TAVI are required.
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spelling pubmed-45921722015-10-14 Performance of Surgical Risk Scores to Predict Mortality after Transcatheter Aortic Valve Implantation Silva, Leonardo Sinnott Caramori, Paulo Ricardo Avancini Nunes Filho, Antonio Carlos Bacelar Katz, Marcelo Guaragna, João Carlos Vieira da Costa Lemos, Pedro Lima, Valter Abizaid, Alexandre Tarasoutchi, Flavio de Brito Jr, Fabio S. Arq Bras Cardiol Original Article BACKGROUND: Predicting mortality in patients undergoing transcatheter aortic valve implantation (TAVI) remains a challenge. OBJECTIVES: To evaluate the performance of 5 risk scores for cardiac surgery in predicting the 30-day mortality among patients of the Brazilian Registry of TAVI. METHODS: The Brazilian Multicenter Registry prospectively enrolled 418 patients undergoing TAVI in 18 centers between 2008 and 2013. The 30-day mortality risk was calculated using the following surgical scores: the logistic EuroSCORE I (ESI), EuroSCORE II (ESII), Society of Thoracic Surgeons (STS) score, Ambler score (AS) and Guaragna score (GS). The performance of the risk scores was evaluated in terms of their calibration (Hosmer–Lemeshow test) and discrimination [area under the receiver–operating characteristic curve (AUC)]. RESULTS: The mean age was 81.5 ± 7.7 years. The CoreValve (Medtronic) was used in 86.1% of the cohort, and the transfemoral approach was used in 96.2%. The observed 30-day mortality was 9.1%. The 30-day mortality predicted by the scores was as follows: ESI, 20.2 ± 13.8%; ESII, 6.5 ± 13.8%; STS score, 14.7 ± 4.4%; AS, 7.0 ± 3.8%; GS, 17.3 ± 10.8%. Using AUC, none of the tested scores could accurately predict the 30-day mortality. AUC for the scores was as follows: 0.58 [95% confidence interval (CI): 0.49 to 0.68, p = 0.09] for ESI; 0.54 (95% CI: 0.44 to 0.64, p = 0.42) for ESII; 0.57 (95% CI: 0.47 to 0.67, p = 0.16) for AS; 0.48 (95% IC: 0.38 to 0.57, p = 0.68) for STS score; and 0.52 (95% CI: 0.42 to 0.62, p = 0.64) for GS. The Hosmer–Lemeshow test indicated acceptable calibration for all scores (p > 0.05). CONCLUSIONS: In this real world Brazilian registry, the surgical risk scores were inaccurate in predicting mortality after TAVI. Risk models specifically developed for TAVI are required. Sociedade Brasileira de Cardiologia 2015-09 /pmc/articles/PMC4592172/ /pubmed/26247244 http://dx.doi.org/10.5935/abc.20150084 Text en http://creativecommons.org/licenses/by/4.0/ This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Original Article
Silva, Leonardo Sinnott
Caramori, Paulo Ricardo Avancini
Nunes Filho, Antonio Carlos Bacelar
Katz, Marcelo
Guaragna, João Carlos Vieira da Costa
Lemos, Pedro
Lima, Valter
Abizaid, Alexandre
Tarasoutchi, Flavio
de Brito Jr, Fabio S.
Performance of Surgical Risk Scores to Predict Mortality after Transcatheter Aortic Valve Implantation
title Performance of Surgical Risk Scores to Predict Mortality after Transcatheter Aortic Valve Implantation
title_full Performance of Surgical Risk Scores to Predict Mortality after Transcatheter Aortic Valve Implantation
title_fullStr Performance of Surgical Risk Scores to Predict Mortality after Transcatheter Aortic Valve Implantation
title_full_unstemmed Performance of Surgical Risk Scores to Predict Mortality after Transcatheter Aortic Valve Implantation
title_short Performance of Surgical Risk Scores to Predict Mortality after Transcatheter Aortic Valve Implantation
title_sort performance of surgical risk scores to predict mortality after transcatheter aortic valve implantation
topic Original Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4592172/
https://www.ncbi.nlm.nih.gov/pubmed/26247244
http://dx.doi.org/10.5935/abc.20150084
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