Clin Res Cardiol 101, Suppl 1, April 2012
V1144 - The STS-Score outperforms the EuroSCORE in predicting outcome following transcatheter aortic valve implantation
 
K. Hemmann1, J. Weber2, M. Sirotina2, N. Wunderlich2, A. Moritz3, A. M. Zeiher1, V. Schächinger4, M. Doss3, H. Sievert2, S. Fichtlscherer1, R. Lehmann1
 
1Zentrum Innere Medizin III, Schwerpunkt Kardiologie, Universitätsklinikum Frankfurt am Main, Frankfurt am Main; 2St. Katharinen-Krankenhaus, Cardiovaskuläres Centrum Frankfurt, Frankfurt am Main; 3Klinik für Thorax-, Herz- und Thorakale Gefäßchirurgie, Universitätsklinikum Frankfurt am Main, Frankfurt am Main; 4Medizinische Klinik I, Klinikum Fulda gAG, Fulda;
 
Background: Transcatheter aortic valve implantation (TAVI) was developed as new innovative therapy for inoperable patients and surgical high-risk patients as an alternative to traditional aortic valve replacement. After a successful index procedure, further prognosis was suggested to be influenced mainly by comorbidities. However an appropriate risk score especially predicting long-term outcome following TAVI is not available to date. The aim of this study was to identify predictors of adverse short- and long-term outcome.
Methods: This is a two-center registry study including all TAVI procedures performed at the University Hospital and CardioVascular Center  of Frankfurt, Germany (January 2005 to August 2011). A total of 240 transfemoral (TF), 131 transapical (TA) and 7 transsubclavian (TS) TAVI procedures were analyzed regarding long-term survival. Beyond evaluation of clinical and functional characteristics, EuroSCORE and STS-Score were calculated.
Results: Observed 30-day Mortality was 5% in the TF and 13% in the TA patients. In the transfemoral cohort the EuroSCORE was significantly lower compared to the transapical cohort (18.2±12.4 vs. 23.1±15.4 ; p<0.001). TF patients showed a slightly better survival compared to TA patients, mainly driven by a lower early mortality (see Figure).
Patients with a STS-Score above the median experienced a nearly sixfold elevation in 30-day-mortality (HR 5.8; 95% CI 2.0-16.8), whereas the logistic EuroSCORE (HR 1.9; 95% CI 0.9-4.3) did not predict adverse 30-day-outcome. Furthermore, age above 80 years was associated with an elevated 30-day-mortality (HR 2.7; 95% CI 1.1-6.6). The hazard ratio (HR) of TF cases compared to TA cases was 0.4 (95% CI 0.2-0.8). In the multivariable analysis, only the STS-Score remained as independent predictor of adverse 30-day-outcome (HR 4.1; 95%CI 1.4-12.1), whereas femoral access was an independent predictor for a favorable short-term outcome (HR 0.4; 95%CI 0.2-0.9).
In addition, a 30-day landmark analysis was performed to distinguish between short-term and long-term predictors. Independent predictors of long-term mortality (multivariable Cox-regression analysis) were the STS-Score (HR 2.0; 95%CI 1.2-3.4) and a preprocedural moderate to severe mitral regurgitation (HR 1.7; 95%CI 1.0-2.9). Neither the EuroSCORE, nor age or the valve type (Edwards Sapien® vs. Medtronic CoreValve®) were predictors of long-term mortality. No other independent risk predicting factors including analysis of postprocedural echocardiographic data could be found.


 

Kaplan-Meier-Survival Curve

Conclusions: The STS-Score outperforms the logistic EuroSCORE in predicting adverse outcome following TAVI. The apical approach is associated with a higher mortality mainly driven by more preexisting comorbidities. A moderate to severe preprocedural mitral regurgitation is associated with an adverse outcome regarding long-term survival.
 

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/V1144.htm