Survival posT Tavi: the STT score.

Reference: Am J Cardiol. 2014 Sep 28;114(12):1867-1874

 

Survival posT Tavi: the STT score. Derivation and external validation.

D'Ascenzo F1, Capodanno D2, Tarantini G3, Nijhoff F4, Ciuca C5, Rossi ML6, Brambilla N7, Barbanti M2, Napodano M3, Stella P8, Saia F5, Ferrante G9, Tamburino C2, Gasparetto V3, Agostoni P4, Marzocchi A5, Presbitero P6, Bedogni F7, Cerrato E10, Omedè P10, Conrotto F11, Salizzoni S12, Biondi Zoccai G13, Marra S11, Rinaldi M12, Gaita F10, D'Amico M11, Moretti C14.

Città della Salute e della Scienza Hospital, Division of Cardiology 2 (FC; PS; GF; CM; MDA; SM); Città Della Salute e della Scienza Hospital, Division of Cardiology, University of Turin (FDA; EC; CM); Città Della Salute e della Scienza Hospital, Division of Cardiac Surgery, University of Turin (SS; LTM; MR);  Ferrarotto Hospital, University of Catania, Catania (CT; MB);  Division of Cardiology, Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, Italy (GT; VG; MN); Istituto Humanitas, Division of Cardiology (PP; MM; MLR); University Medical Center Utrecht (FN; PS, PA); Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome (GBZ)

Cardiogroup.org on-line STT score computation: Dr. Enrico Cerrato, info: enrico.cerrato [at] gmail.com

Address of correspondence Dr. Fabrizio D’Ascenzo, info: fabrizio.dascenzo [at] gmail.com

 

ABSTRACT.

Introduction and MethodsSurgical risk scores fail to accurately predict mortality after transcatheter aortic valve implantation (TAVI). The aim of this study was to develop and validate a dedicated risk score for accurate estimation of mortality risk in these patients. All consecutive patients who underwent TAVI at 6 international institutions were enrolled. Predictors for 1-year all-cause mortality were identified by means of Cox multivariate analysis and incorporated in a prediction score. Accuracy of the score was derived and externally validated for 30-day and 1-year mortality. The net classification improvement compared with the Society of Thoracic Surgeons (STS) score was appraised. A total of 1,064 patients constituted the derivation cohort and 180 patients constituted the external validation cohort

Results and ConclusionsA total of 165 patients (15%) died at 1-year follow-up. Previous stroke (odds ratio [OR] 1.80, 1.4 to 3), inverse of renal clearance (OR 8, 6 to 14), and systolic pulmonary arterial pressure ?50 mm Hg (OR 2.10, 1.5 to 3) were independently related to 1-year mortality. Area under the curve (AUC) of the survival post TAVI (STT) for 1-year mortality was 0.68 (0.62 to 0.71). At 30 days, 65 patients (7%) had died and the AUC for the STT at this time point was 0.66 (0.64 to 0.75). In the external validation cohorts, the AUC of the STT were 0.66 (0.56 to 0.7) for 30-day and 0.67 (0.62 to 0.71) for 1-year mortality. Net reclassification improvement for STT compared with STS was 31% (p <0.001) for 30-day mortality and 14% (p <0.001) for 1-year mortality. In conclusion, the STT score represents an easy and accurate tool to assess the risk of short-term and mid-term mortality in patients undergoing TAVI.

On the left ROC of STT  for all cause 30 days death on external validation cohort (0.66 0.56-0.7). On the right ROC of STT  for all cause death at follow up on external validation cohort (ROC 0.67: 0.62-0.71)