Clin Res Cardiol 101, Suppl 1, April 2012

V1143 - The Revised EuroSCORE II for the Prediction of Mortality in Patients undergoing Transcatheter Aortic Valve Implantation
 
A. Sedaghat1, J.-M. Sinning1, M. Vasa-Nicotera1, A. Ghanem1, C. Hammerstingl1, E. Grube1, G. Nickenig1, N. Werner1
 
1Medizinische Klinik und Poliklinik II, Universitätsklinikum Bonn, Bonn;
 
Background: The assessment of procedural risk plays a crucial role in the screening process of patients with severe symptomatic aortic stenosis. Estimated mortality influences the decision whether a patient should preferably undergo surgical aortic valve replacement or transcatheter aortic valve implantation (TAVI). Logistic EuroSCORE and STS-score are currently used to estimate procedural risk and mortality for transcatheter valve implantation. The comparison of both scoring systems concerning their discriminative power for mortality in TAVI patients has shown a better performance of the STS score, whereas logistic EuroSCORE tends to overestimate mortality in percutaneous valve replacement. Recently, the revised EuroSCORE II has been introduced at the EACTS meeting 2011 in Lisbon/Portugal.
Objective: The aim of this study was to compare the predictive ability of the new EuroSCORE II to the established logistic EuroSCORE and STS-score for perioperative and 1-year mortality in patients undergoing percutaneous valve implantation.
Methods: The new EuroSCORE II was calculated in 146 TAVI patients using the webbased EuroSCORE calculator (www.euroscore.org) and compared to the established logistic EuroSCORE and STS mortality score by ROC-curve analysis.
Results: 146 patients (Age 80.6 ± 6.4 years, left-ventricular ejection fraction 45.2 ± 14.5%, 48.6% male) underwent TAVI with use of the Medtronic CoreValve prosthesis between 2008 and 2011. The EuroSCORE II and STS-score (r=0.51, p<0.001) showed a good correlation, whereas a strong correlation was found between EuroSCORE II and logistic EuroSCORE (r= 0.70, p<0.001).
30-day and 1-year mortality rate were 5.5% (8/146) and 23.3% (34/146) (median follow up of 392 days). All three scoring systems were significantly increased in non-survivors compared to survivors at 30 days and at 1 year. The in-hospital mortality rate was estimated as the following by the logistic EuroSCORE: 31.1 ± 18.5%, the STS score: 9.6 ± 7.3%, and the EuroSCORE II: 10.0 ± 7.5%.
The prognostic value of the logistic EuroSCORE, STS-score, and the recent EuroSCORE II systems was analyzed in ROC curve analyses for the prediction of 30-day (AUC: 0.82 vs. 0.69 vs. 0.76) and 1-year mortality (AUC: 0.74 vs. 0.66 vs. 0.74).
A Euroscore II ≥10 was related to an approximately three-fold increased mortality risk at 1 year (HR 2.9, 95%-CI: 1.4-5.7); p=0.03).
Conclusion: In percutaneous TAVI patients, the new EuroSCORE II is superior to the STS-score in predicting early and late mortality. However, it does not provide additional prognostic information beyond the established logistic EuroSCORE. For more exact risk prediction in TAVI, a distinct TAVI risk score would be desirable.


 


 

Clin Res Cardiol 101, Suppl 1, April 2012
Zitierung mit Vortrags- oder Posternummer s.o.
DOI 10.1007/s00392-012-1100-6

http://www.abstractserver.de/dgk2012/ft/abstracts/V1143.htm