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Inadequacy of existing clinical prediction models for predicting mortality after transcatheter aortic valve implantation

BACKGROUND: 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, OBSERVA...

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Autores principales: Martin, Glen P., Sperrin, Matthew, Ludman, Peter F., de Belder, Mark A., Gale, Chris P., Toff, William D., Moat, Neil E., Trivedi, Uday, Buchan, Iain, Mamas, Mamas A.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Mosby 2017
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5333927/
https://www.ncbi.nlm.nih.gov/pubmed/28224933
http://dx.doi.org/10.1016/j.ahj.2016.10.020
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author Martin, Glen P.
Sperrin, Matthew
Ludman, Peter F.
de Belder, Mark A.
Gale, Chris P.
Toff, William D.
Moat, Neil E.
Trivedi, Uday
Buchan, Iain
Mamas, Mamas A.
author_facet Martin, Glen P.
Sperrin, Matthew
Ludman, Peter F.
de Belder, Mark A.
Gale, Chris P.
Toff, William D.
Moat, Neil E.
Trivedi, Uday
Buchan, Iain
Mamas, Mamas A.
author_sort Martin, Glen P.
collection PubMed
description BACKGROUND: 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. METHODS: 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. RESULTS: 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. CONCLUSIONS: 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.
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spelling pubmed-53339272017-03-09 Inadequacy of existing clinical prediction models for predicting mortality after transcatheter aortic valve implantation Martin, Glen P. Sperrin, Matthew Ludman, Peter F. de Belder, Mark A. Gale, Chris P. Toff, William D. Moat, Neil E. Trivedi, Uday Buchan, Iain Mamas, Mamas A. Am Heart J Clinical Investigation BACKGROUND: 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. METHODS: 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. RESULTS: 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. CONCLUSIONS: 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. Mosby 2017-02 /pmc/articles/PMC5333927/ /pubmed/28224933 http://dx.doi.org/10.1016/j.ahj.2016.10.020 Text en © 2016 The Authors http://creativecommons.org/licenses/by/4.0/ This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).
spellingShingle Clinical Investigation
Martin, Glen P.
Sperrin, Matthew
Ludman, Peter F.
de Belder, Mark A.
Gale, Chris P.
Toff, William D.
Moat, Neil E.
Trivedi, Uday
Buchan, Iain
Mamas, Mamas A.
Inadequacy of existing clinical prediction models for predicting mortality after transcatheter aortic valve implantation
title Inadequacy of existing clinical prediction models for predicting mortality after transcatheter aortic valve implantation
title_full Inadequacy of existing clinical prediction models for predicting mortality after transcatheter aortic valve implantation
title_fullStr Inadequacy of existing clinical prediction models for predicting mortality after transcatheter aortic valve implantation
title_full_unstemmed Inadequacy of existing clinical prediction models for predicting mortality after transcatheter aortic valve implantation
title_short Inadequacy of existing clinical prediction models for predicting mortality after transcatheter aortic valve implantation
title_sort inadequacy of existing clinical prediction models for predicting mortality after transcatheter aortic valve implantation
topic Clinical Investigation
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5333927/
https://www.ncbi.nlm.nih.gov/pubmed/28224933
http://dx.doi.org/10.1016/j.ahj.2016.10.020
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