SPC365

Comparison of mortality scores performance in transcatheter aortic valve replacement: suiting up to percutaneous intervention

Session: Comunicações Orais - Sessão 23 - Intervenção Valvular Aórtica Percutânea
Speaker: Pedro Alves Da Silva

Congress: CPC 2023
Topic: F. Valvular, Myocardial, Pericardial, Pulmonary, Congenital Heart Disease
Theme: 15. Valvular Heart Disease
Subtheme: 15.4 Valvular Heart Disease – Treatment
Session Type: Comunicações Orais
FP Number: ---
Authors: Pedro Alves Da Silva; Beatriz Silva; Joana Brito; Ana Margarida Martins; Beatriz Garcia; Catarina Oliveira; Miguel Raposo; Ana Abrantes; Catarina Gregório; Daniel Cazeiro; Cláudia Jorge; Miguel Nobre Menezes; Pedro Carrilho-Ferreira; Pedro Pinto Cardoso; Fausto J Pinto

<p><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-size:10.5pt">Introduction</span></strong></span></span></p>

<p><span style="font-size:12pt"><span style="background-color:white"><span style="font-family:&quot;Times New Roman&quot;,serif"><span style="font-size:11.0pt"><span style="font-family:&quot;Calibri&quot;,sans-serif"><span style="color:black">As transcatheter aortic valve replacement (TAVR) is increasingly relevant for patients with severe symptomatic aortic stenosis, having a reliable procedure specific risk-prediction tool is paramount to provide high-quality care. Surgical scores as </span></span></span><span style="font-size:11.0pt"><span style="font-family:&quot;Calibri&quot;,sans-serif"><span style="color:#212529">the EuroScore II and the Society of Thoracic Surgeons (STS) score II<sup> </sup>have been widely used to identify patients with high surgical risk in whom percutaneous treatment might be more favorable. However, </span></span></span><span style="font-size:11.0pt"><span style="background-color:white"><span style="font-family:&quot;Calibri&quot;,sans-serif"><span style="color:#212121">current literature lacks a consensual specific predictive model for short-term and mid-term prognosis in patients undergoing transcatheter aortic valve implantation (TAVI). </span></span></span></span></span></span></span></p>

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<p><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-size:11.0pt"><span style="color:#212529">Purpose: </span></span></strong></span></span></p>

<p><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><span style="font-size:11.0pt"><span style="color:#212529">We aimed to access short and midterm (30 days and one year) mortality and to access the ability of a directly adapted score in estimating mortality in a real-world population.</span></span></span></span></p>

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<p><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-size:11.0pt"><span style="color:#212529">Methods</span></span></strong><span style="font-size:11.0pt"><span style="font-family:&quot;acumin-pro&quot;,serif"><span style="color:#212529">:</span></span></span></span></span></p>

<p><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><span style="font-size:11.0pt"><span style="color:#212529">We conducted a retrospective observational study in patients who implanted TAVR in a single center. Surgical mortality scores &ndash; EUROSCORE II and STS score II &ndash; and adapted score Society of Thoracic Surgeons (STS)/American College of Cardiology (ACC) transcatheter valve therapy (TVT) score were used to estimate mortality. Predictive abilities of these three scores were compared using area under the receiver operating characteristics (ROC) curve for 30-day and one year mortality.</span></span></span></span></p>

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<p><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-size:11.0pt"><span style="color:#212529">Results</span></span></strong><span style="font-size:11.0pt"><span style="color:#212529">: </span></span></span></span></p>

<p><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><span style="font-size:11.0pt"><span style="color:#212529">From January 2018 to December 2021, 416 patients were submitted to TAVR procedure in our center. The mean age was 83+-6 years old and 229 (55%) were female. 94% had hypertension, 80% dyslipidemia, 40% diabetes mellitus, 35% coronary artery disease, 32% chronic kidney disease. Mean ejection fraction was 56%. </span></span></span></span></p>

<p><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><span style="font-size:11.0pt"><span style="color:#212529">During a mean follow-up (FUP) of 816 &plusmn; 492 days, 30-day mortality was 1,7% and after 1 year mortality rate was 12,2% (higher than reported in PARTNER 3 trial, 8,5%). </span></span></span></span></p>

<p><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><span style="font-size:11.0pt"><span style="color:#212529">The Mean EuroSCORE was 3,4</span></span><span style="font-size:11.0pt"><span style="font-family:Symbol"><span style="color:#212529">&plusmn;</span></span></span><span style="font-size:11.0pt"><span style="color:#212529">3,2, mean STS-II 3,9</span></span><span style="font-size:11.0pt"><span style="font-family:Symbol"><span style="color:#212529">&plusmn;</span></span></span><span style="font-size:11.0pt"><span style="color:#212529">1,8 and mean value for STS/ACC-TVT score was 3,55</span></span><span style="font-size:11.0pt"><span style="font-family:Symbol"><span style="color:#212529">&plusmn;</span></span></span><span style="font-size:11.0pt"><span style="color:#212529">1,34. ROC curve analysis showed a significantly higher discriminative power of STS/ACC-TVT (AUC 0,749, 95% CI 0,681-0,818) compared with surgical scores (p=0,001) &ndash; figure 1.</span></span></span></span></p>

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<p><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><span style="font-size:11.0pt"><span style="color:#212529">We also divided population into quartiles and compared the mortality rate at 30 days and 1 year in each quartile using either STSII or STS/ACC-TVT; As can be seen in figure 2, mortality rates correlated better with the STS/ACC-TVT score than with the STS score.</span></span></span></span></p>

<p><span style="font-size:12pt"><span style="background-color:white"><span style="font-family:&quot;Times New Roman&quot;,serif"><strong><span style="font-size:11.0pt"><span style="font-family:&quot;Calibri&quot;,sans-serif"><span style="color:#212529">Conclusion</span></span></span></strong><span style="font-size:11.0pt"><span style="font-family:&quot;Calibri&quot;,sans-serif"><span style="color:#212529">: A score adapted to a TAVI population showed better predictive capacity than traditional surgical scores. Less preponderance of previous surgical status, relevance of access site and more adapted weight of age might explain the best performance of STS/ACC-TVT score. Surgical scores are helpful in choosing treatment option, but adapted scores are better to predict pos-TAVR mortality.</span></span></span></span></span></span></p>