Early and Late Mortality in Patients Undergoing Transcatheter Aortic Valve Implantation: Comparison of the Novel EuroScore II with Established Risk Scores

Abstract

Objectives: In the evaluation of patients considered for transcatheter aortic valve implantation (TAVI), the EuroScore II might be superior to established risk scores. Methods: We assessed the performance of the EuroScore II in predicting mortality in a cohort of 350 TAVI patients. Results: The EuroScore II and the logistic EuroScore were higher in nonsurvivors compared to survivors at 30 days (12.6 ± 1.8 vs. 7.5 ± 0.3%, p < 0.001 for EuroScore II, and 27.7 ± 2.8 vs. 22.1 ± 0.8%, p = 0.04 for logistic EuroScore), while the STS-PROM score did not differ (7.3 ± 0.8 vs. 6.4 ± 0.3%, p = 0.09). The area under the curve (AUC) was 0.70 for the EuroScore II, 0.61 for the logistic EuroScore and 0.59 for the STS-PROM score for predicting 30-day mortality. Based on the estimated 30-day mortality risk, 3 risk groups were identified, a low-risk (EuroScore II ≤4%, 30-day mortality 1.2%), an intermediate-risk (EuroScore II between 4% and 9%, 30-day mortality 8.6%) and a high-risk group (EuroScore II >9%, 30-day mortality, 17.1%; p = 0.03). Regarding cumulative mortality, the AUC was 0.67 for the EuroScore II, 0.62 for the logistic EuroScore and 0.55 for the STS-PROM score for predicting mortality at total follow-up. Conclusions: In this patient cohort, the EuroScore II performed best in predicting short- and long-term mortality.

EuroSCORE II and STS as mortality predictors in patients undergoing TAVI

“…Despite that, in our study, STS score did not prove to be better able to predict mortality. 16 A finding in this study was that the left ventricular ejection fraction of patients who progressed to death was significantly higher than seen in the survivors (65.25±1.74% for death and 54.58±14.18 for survival; p=0.03). However, the average of the two groups was within the normal range and none of the witnessed deaths was due to cardiogenic shock.…”

“…While Stahli et al 16 in a cohort of 350 patients and Sedaghat et al 15 in a cohort of 206 patients demonstrated the superiority of EuroSCORE II, Hemmann et al 17 in a record of 426 patients considered the STS superior. Other studies, as well as our work, demonstrated no difference between the scores, and, in our case, both the EuroSCORE II and STS scores had the ability to predict mortality, with AUC of 0.77 and 0.81, respectively.…”

“…15,16 In addition, TAVI patients are usually elderly, with greater surgical risk and with numerous risk factors often not included in the current scores. [7][8][9]15,16 For these reasons, there is a need to identify predictors that help distinguish patients who may not benefit from the percutaneous procedure.…”

Outcomes after Transcatheter Aortic Valve Implantation: a Single Center Registry of 350 Consecutive Cases

“…In the whole patient cohort, all-cause mortality was 9.1% at 30 days [18]. Causes of death at 30 days were cardiovascular in 96.8% (31 of 32) of patients.…”

Who is the next for aortic valve implantation? Present and future indications

“…Recently several studies have focused their attention on the large proportion of AS population defined at intermediate-risk (STS risk score between 4% and 8%) and at low-risk (STS risk score < 4%) [26,27] . Under current guidelines, the choice to perform TAVI for that group of patients should be allowed only after a specific cases selection by the Heart Team and, importantly, in centers with well-established procedural training.…”