PDF(Pubmed)
Abstract：
UNASSIGNED: The Society of Thoracic Surgeons (STS) score has been used to risk stratify patients undergoing transcatheter aortic valve replacement (TAVR). The Transcatheter Valve Therapy (TVT) score was developed to predict in-hospital mortality in high/prohibitive-risk patients. Its performance in low and intermediate-risk patients is unknown. We sought to compare TVT and STS scores\' ability to predict clinical outcomes in all-surgical-risk patients undergoing TAVR.
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.
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.
摘要：
■胸外科医师协会（STS）评分已用于对接受经导管主动脉瓣置换术（TAVR）的患者进行风险分层。制定了经导管瓣膜治疗（TVT）评分来预测高危/禁忌症患者的院内死亡率。其在低危和中危患者中的表现尚不清楚。我们试图比较TVT和STS评分预测接受TAVR的所有手术风险患者临床结果的能力。
■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。
■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。
