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. 2023 Apr 21;2(3):100600.
doi: 10.1016/j.jscai.2023.100600. eCollection 2023 May-Jun.

Assessment of TVT and STS Risk Score Performances in Patients Undergoing Transcatheter Aortic Valve Replacement

Karim Al-Azizi  1 , Emily Shih  2   3 , J Michael DiMaio  2   3 , John J Squiers  2 , Ghadi Moubarak  3 , Austin Kluis  3 , Jasjit K Banwait  3 , William H Ryan  2 , Molly I Szerlip  1 , Srinivasa P Potluri  1 , Mohanad Hamandi  3 , Allison T Lanfear  3 , Talia G Meidan  3 , Robert C Stoler  4 , Timothy A Mixon  5 , Anita R Krueger  6 , Michael J Mack  2   3
Affiliations

Assessment of TVT and STS Risk Score Performances in Patients Undergoing Transcatheter Aortic Valve Replacement

Karim Al-Azizi et al. J Soc Cardiovasc Angiogr Interv. .

Abstract

Background: The Society of Thoracic Surgeons (STS) score has been used to risk stratify patients undergoing transcatheter aortic valve replacement (TAVR). The Transcatheter Valve Therapy (TVT) score was developed to predict in-hospital mortality in high/prohibitive-risk patients. Its performance in low and intermediate-risk patients is unknown. We sought to compare TVT and STS scores' ability to predict clinical outcomes in all-surgical-risk patients undergoing TAVR.

Methods: Consecutive patients undergoing TAVR from 2012-2020 within a large health care system were retrospectively reviewed and stratified by STS risk score. Predictive abilities of TVT and STS scores were compared using observed-to-expected mortality ratios (O:E) and area under the receiver operating characteristics curves (AUCs) for 30-day and 1-year mortality.

Results: We assessed a total of 3270 patients (mean age 79 ± 9 years, 45% female), including 191 (5.8%) low-risk, 1093 (33.4%) intermediate-risk, 1584 (48.4%) high-risk, and 402 (5.8%) inoperable. Mean TVT and STS scores were 3.5% ± 2.0% and 6.1% ± 4.3%, respectively. Observed 30-day and 1-year mortality were 2.8% (92/3270; O:E TVT 0.8 ± 0.16 vs STS 0.46 ± 0.09), and 13.2% (432/3270), respectively. In the all-comers population, both TVT and STS risk scores showed poor prediction of 30-day (AUC: TVT 0.68 [0.62-0.74] vs STS 0.64 [0.58-0.70]), and 1-year (AUC: TVT 0.65 [0.62-0.58] vs STS 0.65 [0.62-0.58]) mortality. After stratifying by surgical risk, discrimination of the TVT and STS scores remained poor in all categories at 30 days and 1 year.

Conclusions: An updated TAVR risk score with improved predictive ability across all-surgical-risk categories should be developed based on a larger national registry.

Keywords: aortic stenosis; risk score; transcatheter aortic valve replacement.

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Figures

None
Performance of the STS and TVT score in assessing risk among patients undergoing TAVR.
Figure 1
Figure 1
Receiver operating characteristic curve for TVT and STS-PROM scores. The area under receiver operator characteristics curves was utilized to determine predictive ability of the TVT and STS risk scores across all-risk categories. It demonstrated in short term, the TVT risk score had a higher predictive ability in patients of high and inoperable risk. However, both risk scores had poor-predictive performance across all-risk categories and time point. PROM, predicted risk of mortality; STS, Society of Thoracic Surgeons; TVT, transcatheter valve therapy.
Central Illustration
Central Illustration
Performance of the STS and TVT score in assessing risk among patients undergoing TAVR.
See this image and copyright information in PMC

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