UNASSIGNED: Consecutive patients undergoing TAVR from 2012-2020 within a large health care system were retrospectively reviewed and stratified by STS risk score. Predictive abilities of TVT and STS scores were compared using observed-to-expected mortality ratios (O:E) and area under the receiver operating characteristics curves (AUCs) for 30-day and 1-year mortality.
UNASSIGNED: We assessed a total of 3270 patients (mean age 79 ± 9 years, 45% female), including 191 (5.8%) low-risk, 1093 (33.4%) intermediate-risk, 1584 (48.4%) high-risk, and 402 (5.8%) inoperable. Mean TVT and STS scores were 3.5% ± 2.0% and 6.1% ± 4.3%, respectively. Observed 30-day and 1-year mortality were 2.8% (92/3270; O:E TVT 0.8 ± 0.16 vs STS 0.46 ± 0.09), and 13.2% (432/3270), respectively. In the all-comers population, both TVT and STS risk scores showed poor prediction of 30-day (AUC: TVT 0.68 [0.62-0.74] vs STS 0.64 [0.58-0.70]), and 1-year (AUC: TVT 0.65 [0.62-0.58] vs STS 0.65 [0.62-0.58]) mortality. After stratifying by surgical risk, discrimination of the TVT and STS scores remained poor in all categories at 30 days and 1 year.
UNASSIGNED: An updated TAVR risk score with improved predictive ability across all-surgical-risk categories should be developed based on a larger national registry.
■对2012-2020年在大型医疗保健系统中连续接受TAVR的患者进行回顾性审查,并通过STS风险评分进行分层。使用30天和1年死亡率的观察到的预期死亡率(O:E)和接受者工作特征曲线下的面积(AUC)比较了TVT和STS评分的预测能力。
■我们评估了3270名患者(平均年龄79±9岁,45%女性),包括191个(5.8%)低风险,1093(33.4%)中等风险,1584(48.4%)高风险,402人(5.8%)无法手术。平均TVT和STS评分分别为3.5%±2.0%和6.1%±4.3%,分别。观察到的30天和1年死亡率为2.8%(92/3270;O:ETVT0.8±0.16vsSTS0.46±0.09),和13.2%(432/3270),分别。在所有的人口中,TVT和STS风险评分均显示30天预测较差(AUC:TVT0.68[0.62-0.74]vsSTS0.64[0.58-0.70]),和1年(AUC:TVT0.65[0.62-0.58]vsSTS0.65[0.62-0.58])死亡率。按手术风险分层后,在30天和1年的所有类别中,TVT和STS分数的歧视仍然很差。
■应在更大的国家注册基础上制定更新的TAVR风险评分,提高所有手术风险类别的预测能力。