Abstract 19953: STS Score Variance Results in Risk Reclassification of TAVR Patients
Introduction: Risk assessment using the Society for Thoracic Surgeons (STS) score is a critical element of the Heart Team decision-making process for patients undergoing transcatheter aortic valve replacement (TAVR) in the United States.
Hypothesis: We hypothesized that patients’ STS scores could evolve with time as the study sample in the STS database changes.
Methods: Baseline clinical, STS score, and procedural characteristics were collected prospectively for all patients undergoing TAVR in 2008/9 in a tertiary referral hospital in the United States and recorded in an institutional database. Using the original baseline characteristics recorded in the database in 2008/9, we recalculated the STS score in 2015 using the current online calculator.
Results: 177 patients were included in the study. Mean STS score was 11.6±3.9% and 6.4±2.8% in 2008/9 and 2015, respectively. The mean difference between STS score in 2008/9 and 2015 was -5.2% (limits of agreement -11.7% and 1.3%). 58.7% of patients classified as high risk in 2008/9 would be classified as intermediate risk in 2015 based on STS score alone (see figure, blue shaded area). Mortality at 30 days and 1 year was 11.9% and 27.1%, respectively. Actual 30-day mortality appeared much closer to the 2008/9 STS score (11.6%) than the 2015 score (6.4%).
Conclusions: Changes to the STS score algorithm over time result in significant reduction in calculated STS scores for patients undergoing TAVR. This observation has important implications for the conduct and interpretation of contemporary clinical trials, as there may be considerable unrecognized overlap in risk-defined patient populations.
Author Disclosures: T. Rogers: None. E. Koifman: None. N. Patel: None. A. Steinvil: None. J. Gai: None. R. Torguson: None. P. Okubagzi: None. S. Kiramijyan: None. S. Lee: None. C. Shults: None. L. Satler: None. I. Ben-Dor: None. A. Pichard: None. P. Corso: None. R. Waksman: Consultant/Advisory Board; Modest; Biotronik.
- © 2016 by American Heart Association, Inc.