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Performance of surgical risk scores predicting short- and long-term mortality following TAVI in patients with acute heart failure
Session:
Painel 10-Doença Valvular 2
Speaker:
Catia Serena
Congress:
CPC 2020
Topic:
F. Valvular, Myocardial, Pericardial, Pulmonary, Congenital Heart Disease
Theme:
15. Valvular Heart Disease
Subtheme:
15.4 Valvular Heart Disease – Treatment
Session Type:
Posters
FP Number:
---
Authors:
Cátia Serena; Cláudio Guerreiro ; Joel Monteiro ; Pedro Gonçalves Teixeira; Pedro Queiros; Ana Raquel Barbosa; Mariana Silva; Gualter Silva; Alberto Rodrigues; Pedro Braga
Abstract
<p>Introdution: The STS and EuroSCORE II are the most used scores for surgical risk stratification for transcatheter aortic valve implantation (TAVI). However the capacity of said scores to predict short- and long-term mortality following TAVI implanted in an acute setting is unclear. <br /> <br /> Purpose: To evaluate the performance of the EuroSCORE II and STS as predictors of 30-day and 1-year mortality in patients with severe aortic stenosis and acute heart failure requiring urgent intervention. <br /> <br /> Methods: Retrospective analysis of all consecutively admitted patients with severe aortic stenosis and decompensated heart failure referred for urgent TAVI during the index admission between September 2007-2017. The scores’ discriminative power to predict 30-day and 1 year mortality was evaluated using receiver operating characteristic curve (ROC) and area under the curve (AUC) with a 95% confidence interval. <br /> <br /> Results: Study population composed of 112 patients, mean age was 79±6,8 years (n=112) and 55,4% were men. One quarter of the patients presented with severely depressed ejection fraction and 38% where in NYHA class IV at the time of the intervention. The mean EuroSCORE II was 8,4±5,9% and STS for mortality and morbidity was 8,6±5,8% and 57,8±93,9% respectively. Transfemoral approach was performed in 92%, transapical in 5,4%, transaortic and transsubclavian in less than 1%. Observed procedural mortality was 2,7% (n=3), 30-day mortality 12,5% (n=14) and mortality at 1-Year was 22,3% (n=25). At 30 days, both the STS and EuroScoreII scores performed poorly at predicting mortality (AUC: STS = 0.675 IC 0.532-0.818; EuroScore II = 0.648, IC 0.504-0.793). The same low performance status was observed at 1 year (AUC: STS = 0.613 IC 0.495-0.730; EuroScore II = 0.546 IC 0.420 - 0.672). <br /> <br /> Conclusion: In patients submitted to TAVI in an acute setting, both the STS and EuroScore II showed very poor predictive power for both short and long-term mortality. New risk stratification tools are required for this increasingly common subset of TAVI patients.</p>
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