Wolff, Georg 
ORCID: 0000-0002-1734-6177, Shamekhi, Jasmin, Al-Kassou, Baravan, Tabata, Noriaki, Parco, Claudio ORCID: 0000-0002-2479-3346, Klein, Kathrin, Maier, Oliver, Sedaghat, Alexander, Polzin, Amin, Sugiura, Atsushi, Jung, Christian ORCID: 0000-0001-8325-250X, Grube, Eberhard, Westenfeld, Ralf, Icks, Andrea, Zeus, Tobias, Sinning, Jan-Malte, Baldus, Stephan, Nickenig, Georg, Kelm, Malte and Veulemans, Verena
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Risk modeling in transcatheter aortic valve replacement remains unsolved: an external validation study in 2946 German patients.
Clin. Res. Cardiol..
HEIDELBERG:
SPRINGER HEIDELBERG.
ISSN 1861-0692
Abstract
Background Surgical risk prediction models are routinely used to guide decision-making for transcatheter aortic valve replacement (TAVR). New and updated TAVR-specific models have been developed to improve risk stratification; however, the best option remains unknown. Objective To perform a comparative validation study of six risk models for the prediction of 30-day mortality in TAVR Methods and results A total of 2946 patients undergoing transfemoral (TF,n = 2625) or transapical (TA,n = 321) TAVR from 2008 to 2018 from the German Rhine Transregio Aortic Diseases cohort were included. Six surgical and TAVR-specific risk scoring models (LogES I, ES II, STS PROM, FRANCE-2, OBSERVANT, GAVS-II) were evaluated for the prediction of 30-day mortality. Observed 30-day mortality was 3.7% (TF 3.2%; TA 7.5%), mean 30-day mortality risk prediction varied from 5.8 +/- 5.0% (OBSERVANT) to 23.4 +/- 15.9% (LogES I). Discrimination performance (ROC analysis,c-indices) ranged from 0.60 (OBSERVANT) to 0.67 (STS PROM), without significant differences between models, between TF or TA approach or over time. STS PROM discriminated numerically best in TF TAVR (c-index 0.66; range ofc-indices 0.60 to 0.66); performance was very similar in TA TAVR (LogES I, ES II, FRANCE-2 and GAVS-II all withc-index 0.67). Regarding calibration, all risk scoring models-especially LogES I-overestimated mortality risk, especially in high-risk patients. Conclusions Surgical as well as TAVR-specific risk scoring models showed mediocre performance in prediction of 30-day mortality risk for TAVR in the German Rhine Transregio Aortic Diseases cohort. Development of new or updated risk models is necessary to improve risk stratification. Graphic abstract
| Item Type: | Journal Article | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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| URN: | urn:nbn:de:hbz:38-322616 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| DOI: | 10.1007/s00392-020-01731-9 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Journal or Publication Title: | Clin. Res. Cardiol. | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Publisher: | SPRINGER HEIDELBERG | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Place of Publication: | HEIDELBERG | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| ISSN: | 1861-0692 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Language: | English | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Faculty: | Unspecified | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Divisions: | Unspecified | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Subjects: | no entry | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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| URI: | http://kups.ub.uni-koeln.de/id/eprint/32261 |
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