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. 2023 Feb 28;3(3):376-387.
doi: 10.1016/j.jacasi.2022.11.007. eCollection 2023 Jun.

Race-Specific Impact of Conventional Surgical Risk Score on 1-Year Mortality After Transcatheter Aortic Valve Replacement

Hoyun Kim  1 , Do-Yoon Kang  1 , Jung-Min Ahn  1 , Juyong Brian Kim  2 , Alan C Yeung  2 , Takeshi Nishi  2 , William F Fearon  2 , Eric P Cantey  3 , James D Flaherty  3 , Charles J Davidson  3 , S Christopher Malaisrie  3 , Nayoung Kim  4 , Mijin Kim  1 , Jinho Lee  1 , Jinsun Park  1 , Yeonwoo Choi  1 , Seung-Jung Park  1 , Duk-Woo Park  5
Affiliations

Race-Specific Impact of Conventional Surgical Risk Score on 1-Year Mortality After Transcatheter Aortic Valve Replacement

Hoyun Kim et al. JACC Asia. .

Abstract

Background: Interracial differences in the distribution and prognostic value of conventional Society of Thoracic Surgeons (STS) score on long-term mortality after transcatheter aortic valve replacement (TAVR) are uncertain.

Objectives: This study aims to compare the impact of STS scores on clinical outcomes at 1-year after TAVR between Asian and non-Asian populations.

Methods: We used the Trans-Pacific TAVR (TP-TAVR) registry, a multinational multicenter, observational registry involving patients undergoing TAVR at 2 major centers in the United States and 1 major center in Korea. Patients were classified into 3 groups (low, intermediate, and high-risk) according to the STS score and compared between STS risk groups and race. The primary outcome was all-cause mortality at 1-year.

Results: Among 1,412 patients, 581 were Asian and 831 were non-Asian. The distribution of the STS risk score group was different between Asian and non-Asian groups (62.5% low-, 29.8% intermediate-, and 7.7% high-risk in Asian vs 40.6% low-, 39.1% intermediate-, and 20.3% high-risk in non-Asian). In the Asian population, the all-cause mortality at 1-year was substantially higher in the high-risk STS group than in the low- and intermediate-risk groups (3.6% low-risk, 8.7% intermediate-risk, and 24.4% high-risk; log-rank P < 0.001), which was primarily driven by noncardiac mortality. In the non-Asian group, there was a proportional increase in all-cause mortality at 1-year according to the STS risk category (5.3% low-risk, 12.6% intermediate-risk, and 17.8% high-risk; log-rank P < 0.001).

Conclusions: In this multiracial registry of patients with severe aortic stenosis who underwent TAVR, we identified a differential proportion and prognostic impact of STS score on 1-year mortality between Asian and non-Asian patients (TP-TAVR [Transpacific TAVR Registry]; NCT03826264).

Keywords: Society of Thoracic Surgeons score; aortic valve stenosis; mortality; transcatheter aortic valve replacement.

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Conflict of interest statement

This study was supported by a grant (2020IF0016) from the Asan Institute for Life Sciences and Corporate Relations of Asan Medical Center (Seoul, South Korea) with the NAVER Corp (Seongnam, Korea; www.navercorp.com/en). This study was also funded in part by the CVRF (Seoul, South Korea; www.summitmd.com) and Edwards Lifesciences. The sponsors had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; or preparation, review, and approval of the manuscript; nor in the decision to submit the manuscript for publication. Dr Yeung has received institutional research support from Edwards Lifesciences. Dr Fearon has received institutional research support from Edwards Lifesciences. Dr Malaisrie has received support from Edwards Lifesciences, Medtronic, Cryolife, and Terumo Aortic. Dr S.-J. Park has received grants from Edwards Lifesciences, Medtronic, and Abbott. Dr D.-W. Park has received research grants, consulting, and speaker fees from Edwards Lifesciences, Medtronic, Abbott, and Daiichi Sankyo during the conduct of the study. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.

Figures

None
Graphical abstract
Figure 1
Figure 1
Study Flow Diagram of Patients Study flow diagram and the relative proportion of Society of Thoracic Surgeons (STS) score risk category between Asian and non-Asian groups are shown. TAVR = transcatheter aortic valve replacement; TP-TAVR = Trans-Pacific TAVR registry.
Figure 2
Figure 2
Cumulative Incidence Curves of All-Cause Mortality at 1-Year Kaplan–Meier curves for the primary outcome of all-cause mortality at 1 year, determined by STS score, are shown in (A) Asian and (B) non-Asian patients. P values were obtained from the overall log-rank test. Abbreviation as in Figure 1.
Figure 3
Figure 3
Cumulative Incidence Curves for Cardiac and Noncardiac Mortality at 1-Year (A) Cardiac and (B) noncardiac mortality in Asian patients. (C) Cardiac and (D) noncardiac mortality in non-Asian patients. Abbreviation as in Figure 1.
Figure 4
Figure 4
ROC Curves of the STS Score for 1-Year Mortality Receiver-operating characteristic (ROC) curves for (A) all-cause, cardiac, and noncardiac mortality in Asian patients, and (B) all-cause, cardiac, and noncardiac mortality in non-Asian patients. AUC, Area under the curve; other abbreviations as in Figure 1.
Central Illustration
Central Illustration
Distribution and Clinical Impact of STS Score on Mortality The upper panel shows the distribution of the Society of Thoracic Surgeons (STS) scores between Asian and non-Asian patients, whereas the lower panel shows the primary outcome of all-cause mortality at 1 year according to the STS score and racial group.
See this image and copyright information in PMC

References

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