Document Detail


Comparison between Society of Thoracic Surgeons score and logistic EuroSCORE for predicting mortality in patients referred for transcatheter aortic valve implantation.
MedLine Citation:
PMID:  21741324     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: The primary inclusion criteria from both the Society of Thoracic Surgeons (STS) score and the logistic EuroSCORE are currently used to identify high-risk and inoperable patients eligible for transcatheter aortic valve implantation (TAVI). We aimed to examine the correlation between STS and logistic EuroSCOREs and their performance characteristics in patients referred for TAVI.
METHODS: The study cohort consisted of 718 high-risk patients with severe aortic stenosis who were considered for participation in a TAVI clinical trial. The performance of the STS and logistic EuroSCOREs was evaluated in three groups: (a) medical management or balloon aortic valvuloplasty (BAV), 474 (66%); (b) 133 patients (18.5%) with surgical aortic valve replacement (AVR); (c) 111 (15.4%) with TAVI. The mean age was 81.8 ± 8.1 years, and 394 (54.8%) were female.
RESULTS: The mean STS score was 11.5 ± 6.1, and the mean logistic EuroSCORE was 39.7 ± 23.0. Pearson correlation coefficient showed moderate correlation between the STS and logistic EuroSCOREs (r = 0.61, P < .001). At a median follow-up of 190 days (range, 67-476), 282 patients (39.2%) died. The STS and logistic EuroSCOREs were both higher in patients who died as compared to those in survivors (13.1 ± 6.2 vs.10.0 ± 5.8 and 43.4 ± 23.1 vs. 37.5 ± 22, respectively; P < .001). The observed and predicted 30-day mortality rates in the medical/BAV group were 10.1% observed, 12.3% by STS and 43.1% by logistic EuroSCORE. In the surgical AVR group, the rates were 12.8% observed, 8.4% by STS and 25.6% by logistic EuroSCORE. In the TAVI group, the rates were 11.7% observed, 11.8% by STS and 41.2% by logistic EuroSCORE. The odds ratio (OR) for 30-day mortality in the medical/BAV group was 1.05 (P = .01) with STS and 1.003 (P = .7) with logistic EuroSCORE. In the surgical AVR group, the OR was 1.09 (P = .07) with STS and 1.007 (P = .6) with logistic EuroSCORE. In the TAVI group, the OR was 1.14 (P = .03) with STS and 1.03 (P = .04) with logistic EuroSCORE.
CONCLUSION: In high-risk patients with severe aortic stenosis, STS score is superior to the logistic EuroSCORE in predicting mortality. Clinical judgment should play a major role in the selection of patients with severe aortic stenosis for the different therapeutic options.
Authors:
Itsik Ben-Dor; Michael A Gaglia; Israel M Barbash; Gabriel Maluenda; Camille Hauville; Manuel A Gonzalez; Gabriel Sardi; Ana Laynez-Carnicero; Rebecca Torguson; Petros Okubagzi; Zhenyi Xue; Steven A Goldstein; William O Suddath; Kenneth M Kent; Joseph Lindsay; Lowell F Satler; Augusto D Pichard; Ron Waksman
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Publication Detail:
Type:  Comparative Study; Journal Article     Date:  2011-07-07
Journal Detail:
Title:  Cardiovascular revascularization medicine : including molecular interventions     Volume:  12     ISSN:  1878-0938     ISO Abbreviation:  Cardiovasc Revasc Med     Publication Date:    2011 Nov-Dec
Date Detail:
Created Date:  2011-11-14     Completed Date:  2012-03-02     Revised Date:  2012-07-24    
Medline Journal Info:
Nlm Unique ID:  101238551     Medline TA:  Cardiovasc Revasc Med     Country:  United States    
Other Details:
Languages:  eng     Pagination:  345-9     Citation Subset:  IM    
Copyright Information:
Copyright © 2011. Published by Elsevier Inc.
Affiliation:
Interventional Cardiology, Washington Hospital Center, Washington, DC 20010, USA.
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MeSH Terms
Descriptor/Qualifier:
Aged
Aged, 80 and over
Aortic Valve Stenosis / mortality*,  surgery,  therapy*,  ultrasonography
Balloon Dilation / adverse effects,  mortality*
Discriminant Analysis
District of Columbia
Female
Heart Catheterization / adverse effects,  mortality*
Heart Valve Prosthesis Implantation / adverse effects,  methods,  mortality*
Humans
Logistic Models
Male
Odds Ratio
Retrospective Studies
Risk Assessment
Risk Factors
Severity of Illness Index
Societies, Medical*
Thoracic Surgery*
Time Factors
Treatment Outcome
Comments/Corrections
Comment In:
Cardiovasc Revasc Med. 2012 May-Jun;13(3):183; author reply 184   [PMID:  22406058 ]

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