Abstract 16065: The STS-Score Outperforms the EuroSCORE In Predicting Outcome Following Transcatheter Aortic Valve Implantation
BACKGROUND: Transcatheter aortic valve implantation (TAVI) was developed as new innovative therapy for inoperable patients and high-risk patients as an alternative to traditional aortic valve replacement. After a successful index procedure, further prognosis was suggested to be influenced mainly by comorbidities. However an appropriate risk score predicting long-term outcome following TAVI is not available.
METHODS: This is a two-center registry study including all TAVI procedures performed at the University Hospital and CardioVascular Center of Frankfurt, Germany (January 2005 to August 2011). A total of 424 TAVI procedures (267 transfemoral - TF, 150 transapical - TA and 7 transsubclavian - TS) were performed and analyzed regarding long-term survival.
Results: Observed 30-day Mortality was 4.5% in the TF and 12.5% in the TA patients. In the TF cohort the EuroSCORE was significantly lower compared to the TA cohort (19.5±14.2 vs. 24.4±14.9 ; p<0.001). TF patients showed a slightly better survival compared to TA patients, mainly driven by a lower early mortality (see Figure). Patients with higher STS-Score experienced a 6% elevation in 30-day-mortality per point (HR 1.06; 95% CI 1.01-1.11), whereas the logistic EuroSCORE (HR 1.01; 95% CI 0.98-1.04) did not predict adverse 30-day-outcome. The hazard ratio of TF cases compared to TA cases was 0.41 (95% CI 0.20-0.86). In addition, a 30-day landmark analysis was performed to distinguish between short-term and long-term predictors. The only independent predictor of long-term mortality (multivariable Cox-regression analysis) was the STS-Score (HR 1.05; 95%CI 1.02-1.09). Neither the EuroSCORE, access, nor age or the valve type were predictors of long-term mortality.
CONCLUSIONS: The STS-Score outperforms the logistic EuroSCORE in predicting adverse outcome following TAVI. The apical approach is associated with a higher mortality mainly driven by more preexisting comorbidities.
- © 2012 by American Heart Association, Inc.