Development of a Risk Score to Predict New Pacemaker Implantation After Transcatheter Aortic Valve Replacement

Kiani, Soroosh; Kamioka, Norihiko; Black, George B.; Lu, Marvin; Lisko, John; Rao, Birju; Mengistu, Andenet; Gleason, Patrick; Stewart, James; Caughron, Hope; Dong, Andy; Patel, Hima; Grubb, Kendra J.; Greenbaum, Adam; Devireddy, Chandan; Guyton, Robert A.; Leshnower, Bradley G.; Merchant, Faisal M.; El‐Chami, Mikhael F.; Westerman, Stacy; Lloyd, Michael S.; Babaliaros, Vasilis; Hoskins, Michael

doi:10.1016/j.jcin.2019.07.015

Cited by 73 publications

(72 citation statements)

References 27 publications

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“…Only recently another scoring system to predict the need for PPM implantation after TAVR has been published 36 . Similar to our study, the Emory risk score by Kiani et al validated their scoring system using a second cohort group in their single center study.…”

Section: Discussionsupporting

confidence: 81%

Validation of scoring system predicting permanent pacemaker implantation after transcatheter aortic valve replacement

Shivamurthy

Vejpongsa

Gurung

et al. 2020

Pacing Clinical Electrophis

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Background: Transcatheter aortic valve replacement (TAVR) is being increasingly performed in patients with severe aortic stenosis. Despite newer generation valves, atrioventricular (AV) conduction disturbance is a common complication, necessitating permanent pacemaker (PPM) implantation in about 10% of patients. Hence, it is imperative to improve periprocedural risk stratification to predict PPM implantation after TAVR. The objective of this study was to externally validate a novel risk-stratification model derived from the National Inpatient Sample (NIS) database that predicts risk of PPM from TAVR. Methods:Components of the score included pre-TAVR left and right bundle branch block, sinus bradycardia, second-degree AV block, and transfemoral approach. The scoring system was applied to 917 patients undergoing TAVR at our institution from November 2011 to February 2017. We assessed its predictive accuracy by looking at two components: discrimination using the C-statistic and calibration using the Hosmer-Lemeshow goodness of fit test.Results: Ninety patients (9.8%) required PPM. The scoring system showed good discrimination with C-statistic score of 0.6743 (95% CI: 0.618-0.729). Higher scores suggested increased PPM risk, that is, 7.3% with score ≤3, 19.23% with score 4-6, and 37.50% with score ≥7. Patients requiring PPM were older (81.4 versus 78.7 years, P = .002). Length of stay and in-hospital mortality was significantly higher in PPM group. Conclusions:The NIS database derived PPM risk prediction model was successfully validated in our database with acceptable discriminative and gradation capacity. It is a simple but valuable tool for patient counseling pre-TAVR and in identifying high-risk patients. K E Y W O R D Selectrocardiogram, electrophysiology -basic, electrophysiology -clinical, pacing

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Section: Discussionsupporting

confidence: 81%

Validation of scoring system predicting permanent pacemaker implantation after transcatheter aortic valve replacement

Shivamurthy

Vejpongsa

Gurung

et al. 2020

Pacing Clinical Electrophis

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“…The Emory risk score is the first contemporary scoring system to predict the need for PPM among patients undergoing TAVR [ 9 ]. It was developed by Kiani et al and derived from data from a single institution undergoing Edwards SAPIEN 3 valves.…”

Section: Discussionmentioning

confidence: 99%

“…Most recently, Kiani et al developed the Emory risk score as a tool to aid in the risk stratification of patients undergoing TAVR with SAPIEN 3 balloon-expandable valves. The characteristics of the score include history of syncope, preexisting right bundle branch block (RBBB), QRS duration ≥140 ms, and valve oversizing ≥16% [ 9 ].…”

Section: Introductionmentioning

confidence: 90%

Evaluating the Validity of Risk Scoring in Predicting Pacemaker Rates following Transcatheter Aortic Valve Replacement

Spring

Catalano

Prasad

et al. 2020

Journal of Interventional Cardiology

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Introduction. Requirement of permanent pacemaker (PPM) implantation is a known and common postoperative consequence of transcatheter aortic valve replacement (TAVR). The Emory risk score has been recently developed to help risk stratify the need for PPM insertion in patients undergoing TAVR with SAPIEN 3 valves. Our aim was to assess the validity of this risk score in our patient population, as well as its applicability to patients receiving self-expanding valves. Methods. We conducted a retrospective review of 479 TAVR patients without preoperative pacemakers from November 2016 through December 2018. Preoperative risk factors included in the Emory risk score were collected for each patient: preoperative QRS, preoperative right bundle branch block (RBBB), preoperative syncope, and degree of valve oversizing. Multivariable analysis of the individual variables within the scoring system to identify predictors of PPM placement was performed. The predictive discrimination of the risk score for the risk of PPM placement after TAVR was assessed with the area under the receiver operating characteristic curve (AUC). Results. Our results demonstrated that, of the 479 patients analyzed, 236 (49.3%) received balloon-expandable valves and 243 (50.7%) received self-expanding valves. Pacemaker rates were higher in patients receiving self-expanding valves than those receiving balloon-expandable valves (25.1% versus 16.1%, p = 0.018 ). The Emory risk score showed a moderate correlation with pacemaker requirement in patients receiving each valve type, with AUC for balloon-expandable and self-expanding valves of 0.657 and 0.645, respectively. Of the four risk score components, preoperative RBBB was the only predictor of pacemaker requirement with an AUC of 0.615 for both balloon-expandable and self-expanding valves. Conclusion. In our cohort, the Emory risk score had modest predictive utility for PPM insertion after balloon-expandable and self-expanding TAVR. The risk score did not offer better discriminatory utility than that of preoperative RBBB alone. Understanding the determinants of PPM insertion after TAVR can better guide patient education and postoperative management.

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“…Other risk prediction models have been developed to identify patients at risk for CIED implantation following TAVR (11)(12). However, these models require either data from imaging studies or intraprocedural data, while our risk prediction model relies on clinical data that is easily obtained from most medical records pre-procedurally.…”

Section: Discussionmentioning

confidence: 99%

“…Several risk calculators have been developed to identify patients at risk for post-TAVR CIED implantation (1,(11)(12). Kiani et al reported the Emory Risk Score, however this model was only applicable to patients with balloon-expandable valve (Edwards SAPIEN 3), not for those receiving self-expanding prostheses.…”

Section: Introductionmentioning

confidence: 99%

Risk Prediction Model for Cardiac Implantable Electronic Device Implantation After Transcatheter Aortic Valve Replacement in Patients with Pre-Existing Atrial Fibrillation

Wheat

Tshusima

Kindi

et al. 2020

Preprint

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Introduction High-grade atrioventricular block (AVB) requiring cardiac implantable electronic device (CIED) following transcatheter aortic valve replacement (TAVR) is an important post-procedural complication. Risk prediction models have been developed to identify patients in sinus rhythm at risk for CIED placement following TAVR. Atrial fibrillation (AF) is frequently present in patients referred for TAVR and no risk prediction model has been developed for these patients. This study was undertaken to assess the accuracy of utilizing a previously validated risk prediction model in patients with pre-existing atrial fibrillation (1). Methods and Results This single center, retrospective study analyzed patients with pre-existing AF who underwent TAVR from July 2015 to November 2019. A summative risk prediction score was calculated using a previously described risk prediction model based on the use of a self-expanding valve (1 point), hypertension (1 point), and right bundle branch block on baseline electrocardiogram (2 points), and omitting pre-existing first degree AVB. The model demonstrated good predictive accuracy with an ideal linear regression in calibration plot (R2 = 0.778) and AUC in ROC of 0.652 (95% confidence interval 0.558-0.745). Conclusions Our previously validated risk prediction model accurately predicts the risk of post-TAVR CIED implantation in patients with pre-existing AF.

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Development of a Risk Score to Predict New Pacemaker Implantation After Transcatheter Aortic Valve Replacement

Cited by 73 publications

References 27 publications

Validation of scoring system predicting permanent pacemaker implantation after transcatheter aortic valve replacement

Validation of scoring system predicting permanent pacemaker implantation after transcatheter aortic valve replacement

Evaluating the Validity of Risk Scoring in Predicting Pacemaker Rates following Transcatheter Aortic Valve Replacement

Risk Prediction Model for Cardiac Implantable Electronic Device Implantation After Transcatheter Aortic Valve Replacement in Patients with Pre-Existing Atrial Fibrillation

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