Comparison between Society of Thoracic Surgeons Score and logistic EuroSCORE for predicting mortality in patients referred for transcatheter aortic valve implantation

Background

The primary inclusion criteria from both the Society of Thoracic Surgeons (STS) score and the logistic EuroSCORE are currently used to identify high-risk and inoperable patients eligible for transcatheter aortic valve implantation (TAVI). We aimed to examine the correlation between STS and logistic EuroSCOREs and their performance characteristics in patients referred for TAVI.

Methods

The study cohort consisted of 718 high-risk patients with severe aortic stenosis who were considered for participation in a TAVI clinical trial. The performance of the STS and logistic EuroSCOREs was evaluated in three groups: (a) medical management or balloon aortic valvuloplasty (BAV), 474 (66%); (b) 133 patients (18.5%) with surgical aortic valve replacement (AVR); (c) 111 (15.4%) with TAVI. The mean age was 81.8±8.1 years, and 394 (54.8%) were female.

Results

The mean STS score was 11.5±6.1, and the mean logistic EuroSCORE was 39.7±23.0. Pearson correlation coefficient showed moderate correlation between the STS and logistic EuroSCOREs (r=0.61, P<.001). At a median follow-up of 190 days (range, 67–476), 282 patients (39.2%) died. The STS and logistic EuroSCOREs were both higher in patients who died as compared to those in survivors (13.1±6.2 vs.10.0±5.8 and 43.4±23.1 vs. 37.5±22, respectively; P<.001). The observed and predicted 30-day mortality rates in the medical/BAV group were 10.1% observed, 12.3% by STS and 43.1% by logistic EuroSCORE. In the surgical AVR group, the rates were 12.8% observed, 8.4% by STS and 25.6% by logistic EuroSCORE. In the TAVI group, the rates were 11.7% observed, 11.8% by STS and 41.2% by logistic EuroSCORE. The odds ratio (OR) for 30-day mortality in the medical/BAV group was 1.05 (P=.01) with STS and 1.003 (P=.7) with logistic EuroSCORE. In the surgical AVR group, the OR was 1.09 (P=.07) with STS and 1.007 (P=.6) with logistic EuroSCORE. In the TAVI group, the OR was 1.14 (P=.03) with STS and 1.03 (P=.04) with logistic EuroSCORE.

Conclusion

In high-risk patients with severe aortic stenosis, STS score is superior to the logistic EuroSCORE in predicting mortality. Clinical judgment should play a major role in the selection of patients with severe aortic stenosis for the different therapeutic options.