Relationship between the logistic EuroSCORE and the Society of Thoracic Surgeons Predicted Risk of Mortality score in patients implanted with the CoreValve ReValving System—A Bern-Rotterdam Study

Piazza, Nicolo; Wenaweser, Peter; van Gameren, Menno; Pilgrim, Thomas; Tsikas, Apostolos; Otten, Amber; Nuis, Rutger; Onuma, Yoshinobu; Cheng, Jin Ming; Kappetein, A. Pieter; Boersma, Eric; Juni, Peter; de Jaegere, Peter; Windecker, Stephan; Serruys, Patrick W.

doi:10.1016/j.ahj.2009.11.026

« Previous Next »American Heart Journal
Volume 159, Issue 2 , Pages 323-329, February 2010

Relationship between the logistic EuroSCORE and the Society of Thoracic Surgeons Predicted Risk of Mortality score in patients implanted with the CoreValve ReValving System—A Bern-Rotterdam Study

Nicolo Piazza, MD, FRCPC
- Interventional Cardiology Department, Erasmus Medical Center, Thoraxcenter, Rotterdam, The Netherlands
- Equal contributions.
Peter Wenaweser, MD, PhD
- Interventional Cardiology Department, Bern University Hospital, Bern, Switzerland
- Equal contributions.
Menno van Gameren, MD
- Department of Cardiac Surgery, Thoraxcenter, Erasmus Medical Center, Rotterdam, The Netherlands
Thomas Pilgrim, MD
- Interventional Cardiology Department, Bern University Hospital, Bern, Switzerland
Apostolos Tsikas, MD
- Interventional Cardiology Department, Erasmus Medical Center, Thoraxcenter, Rotterdam, The Netherlands
Amber Otten, MD
- Interventional Cardiology Department, Erasmus Medical Center, Thoraxcenter, Rotterdam, The Netherlands
Rutger Nuis, MD
- Interventional Cardiology Department, Erasmus Medical Center, Thoraxcenter, Rotterdam, The Netherlands
Yoshinobu Onuma, MD
- Interventional Cardiology Department, Erasmus Medical Center, Thoraxcenter, Rotterdam, The Netherlands
Jin Ming Cheng, MD
- Interventional Cardiology Department, Erasmus Medical Center, Thoraxcenter, Rotterdam, The Netherlands
A. Pieter Kappetein, MD, PhD
- Department of Cardiac Surgery, Thoraxcenter, Erasmus Medical Center, Rotterdam, The Netherlands
Eric Boersma, MD, PhD
- Department of Biostatistics and Epidemiology, Erasmus Medical Center, Rotterdam, The Netherlands
Peter Juni, MD, PhD
- Department of Clinical Epidemiology and Biostatistics, Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
Peter de Jaegere, MD, PhD
- Interventional Cardiology Department, Erasmus Medical Center, Thoraxcenter, Rotterdam, The Netherlands
Stephan Windecker, MD, PhD
- Interventional Cardiology Department, Bern University Hospital, Bern, Switzerland
Patrick W. Serruys, MD, PhD
- Interventional Cardiology Department, Erasmus Medical Center, Thoraxcenter, Rotterdam, The Netherlands
- Reprint requests: Patrick W. Serruys, MD, PhD, Department of Cardiology, Erasmus Medical Center, Thoraxcenter, Ba 583a, ′s-Gravendijkwal 230, 3015 CE, Rotterdam, The Netherlands.

Received 28 September 2009; accepted 25 November 2009.

Background

Surgical risk scores, such as the logistic EuroSCORE (LES) and Society of Thoracic Surgeons Predicted Risk of Mortality (STS) score, are commonly used to identify high-risk or “inoperable” patients for transcatheter aortic valve implantation (TAVI). In Europe, the LES plays an important role in selecting patients for implantation with the Medtronic CoreValve System. What is less clear, however, is the role of the STS score of these patients and the relationship between the LES and STS.

Objective

The purpose of this study is to examine the correlation between LES and STS scores and their performance characteristics in high-risk surgical patients implanted with the Medtronic CoreValve System.

Methods

All consecutive patients (n = 168) in whom a CoreValve bioprosthesis was implanted between November 2005 and June 2009 at 2 centers (Bern University Hospital, Bern, Switzerland, and Erasmus Medical Center, Rotterdam, The Netherlands) were included for analysis. Patient demographics were recorded in a prospective database. Logistic EuroSCORE and STS scores were calculated on a prospective and retrospective basis, respectively.

Results

Observed mortality was 11.1%. The mean LES was 3 times higher than the mean STS score (LES 20.2% ± 13.9% vs STS 6.7% ± 5.8%). Based on the various LES and STS cutoff values used in previous and ongoing TAVI trials, 53% of patients had an LES ≥15%, 16% had an STS ≥10%, and 40% had an LES ≥20% or STS ≥10%. Pearson correlation coefficient revealed a reasonable (moderate) linear relationship between the LES and STS scores, r = 0.58, P < .001. Although the STS score outperformed the LES, both models had suboptimal discriminatory power (c-statistic, 0.49 for LES and 0.69 for STS) and calibration.

Conclusions

Clinical judgment and the Heart Team concept should play a key role in selecting patients for TAVI, whereas currently available surgical risk score algorithms should be used to guide clinical decision making.