Abstract 16594: A Risk Prediction Algorithm for 1-Year Mortality After Transcatheter Aortic Valve Implantation
Background: Transcatheter aortic valve implantation (TAVI) is an increasingly common procedure in particular in elderly and multimorbid patients. A pre-procedural risk evaluation scheme beyond the EuroSCORE has not been implemented.
Methods and Results: We followed 500 patients aged 45.4-96.3 years undergoing routine transapical or transfemoral TAVI procedures by commercially available devices, mean age 80.8±6.7, 53% women for 1-year mortality after TAVI. Routinely available variables and logEuroSCORE were determined at baseline. Multivariable Cox regression related clinical data to 1-year mortality (n=123 deaths). Secondary analyses incorporated EuroSCORE data (median EuroSCORE 19.3% (12.0%-28.1%)).
Sex, age, body mass index, atrial fibrillation, estimated glomerular filtration rate, hemoglobin, and left ventricular ejection fraction were most strongly associated with mortality (C-statistic 0.63, 95% confidence interval 0.57 to 0.68). Predicted 1-year risks of mortality were similar to observed risks (calibration Chi2 statistic=6.6; p=0.68).
Net reclassification improvement (34.7%) showed superiority of our risk algorithm in comparison to the EuroSCORE (C-statistic 0.55 (95% confidence interval 0.50 to 0.60)). The score showed good model fit and calibration in external validation in 341 patients, N=80 deaths at one year (C-statistic 0.65, 95% confidence interval 0.59 to 0.71; calibration Chi2 statistic=8.57; p=0.48).
Conclusions: We present a risk evaluation tool derived and validated in routine TAVI cohorts that predicts 1-year mortality better than conventional scoring systems. Our risk algorithm may help to guide decision-making when TAVI is planned.
- © 2013 by American Heart Association, Inc.