Dimitri Arangalage1, Claire Cimadevilla2, Soleiman Alkhoder3, Andrea Chiampan1, Dominique Himbert1, Eric Brochet1, Bernard Iung2, Patrick Nataf3, Jean-Pol Depoix4, Alec Vahanian2, David Messika-Zeitoun5. 1. Department of Cardiology, Assistance publique-Hôpitaux de Paris, Bichat Hospital, Paris, France. 2. Department of Cardiology, Assistance publique-Hôpitaux de Paris, Bichat Hospital, Paris, France; University Paris 7, Faculté de Médecine Paris-Diderot, Paris, France. 3. Department of Cardiac Surgery, Assistance publique-Hôpitaux de Paris, Bichat Hospital, Paris, France. 4. Department of Anesthesiology, Assistance publique-Hôpitaux de Paris, Bichat Hospital, Paris, France. 5. Department of Cardiology, Assistance publique-Hôpitaux de Paris, Bichat Hospital, Paris, France; University Paris 7, Faculté de Médecine Paris-Diderot, Paris, France; INSERM U1148, Bichat Hospital, Paris, France. Electronic address: david.messika-zeitoun@bch.aphp.fr.
Abstract
BACKGROUND: The Logistic European System for Cardiac Operative Risk Evaluation (EuroSCORE) and the Society of Thoracic Surgeons (STS) score are routinely used to identify patients at high surgical risk as potential candidates for transcatheter aortic valve implantation (TAVI). AIMS: To compare the new EuroSCORE II with the Logistic EuroSCORE and the STS score. METHODS: From October 2006 to June 2011, patients with severe symptomatic aortic stenosis who underwent a TAVI were enrolled prospectively. RESULTS: Among 272 patients, the EuroSCORE II was significantly lower and moderately correlated with the Logistic EuroSCORE (9±8% vs. 23±14%, P<0.01; r=0.61, P<0.001), but similar to and poorly correlated with the STS (10±9%, P=0.10; r=0.25, P<0.001). Based on recommended high-risk thresholds (Logistic EuroSCORE≥20%; STS≥10%), a EuroSCORE II≥7% provided the best diagnostic value. However, using the EuroSCORE II, Logistic EuroSCORE or STS score, only 51%, 58% and 37% of patients, respectively, reached these thresholds. Contingency analyses showed that agreements between the EuroSCORE II and the Logistic EuroSCORE or the STS score were modest or poor, respectively, with a risk assessment different in 28% and 36% of patients, respectively. CONCLUSIONS: A EuroSCORE II≥7% corresponded to a Logistic EuroSCORE≥20% or STS score≥10%, but correlations and agreements were at best modest and only approximately half of the patients reached these thresholds. Our results highlight the limits of current scoring systems and reinforce the European guidelines stressing the importance of clinical judgment in addition to risk scores.
BACKGROUND: The Logistic European System for Cardiac Operative Risk Evaluation (EuroSCORE) and the Society of Thoracic Surgeons (STS) score are routinely used to identify patients at high surgical risk as potential candidates for transcatheter aortic valve implantation (TAVI). AIMS: To compare the new EuroSCORE II with the Logistic EuroSCORE and the STS score. METHODS: From October 2006 to June 2011, patients with severe symptomatic aortic stenosis who underwent a TAVI were enrolled prospectively. RESULTS: Among 272 patients, the EuroSCORE II was significantly lower and moderately correlated with the Logistic EuroSCORE (9±8% vs. 23±14%, P<0.01; r=0.61, P<0.001), but similar to and poorly correlated with the STS (10±9%, P=0.10; r=0.25, P<0.001). Based on recommended high-risk thresholds (Logistic EuroSCORE≥20%; STS≥10%), a EuroSCORE II≥7% provided the best diagnostic value. However, using the EuroSCORE II, Logistic EuroSCORE or STS score, only 51%, 58% and 37% of patients, respectively, reached these thresholds. Contingency analyses showed that agreements between the EuroSCORE II and the Logistic EuroSCORE or the STS score were modest or poor, respectively, with a risk assessment different in 28% and 36% of patients, respectively. CONCLUSIONS: A EuroSCORE II≥7% corresponded to a Logistic EuroSCORE≥20% or STS score≥10%, but correlations and agreements were at best modest and only approximately half of the patients reached these thresholds. Our results highlight the limits of current scoring systems and reinforce the European guidelines stressing the importance of clinical judgment in addition to risk scores.
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