Systematic review and meta-analysis of current risk models in predicting short-term mortality after transcatheter aortic valve replacement

Tariq Jamal Siddiqi, Muhammad Shariq Usman, Muhammad Shahzeb Khan, Muhammad Arbaz Arshad Khan, Haris Riaz, Safi U. Khan, M. Hassan Murad, Clifford J. Kavinsky, Rami Doukky, Ankur Kalra, Milind Y. Desai, Deepak L. Bhatt

Research output: Contribution to journalReview articlepeer-review

1 Scopus citations

Abstract

Aims: The aim of this study was to evaluate the performance of risk stratification models (RSMs) in predicting short-term mortality after transcatheter aortic valve replacement (TAVR). Methods and results: MEDLINE and Scopus were queried to identify studies which validated RSMs designed to assess 30-day or in-hospital mortality after TAVR. Discrimination and calibration were assessed using C-statistics and observed/expected ratios (OERs), respectively. C-statistics were pooled using a random- effects inverse-variance method, while OERs were pooled using the Peto odds ratio. A good RSM is defined as one with a C-statistic >0.7 and an OER close to 1.0. Twenty-four studies (n=68,215 patients) testing 11 different RSMs were identified. Discrimination of all RSMs was poor (C-statistic <0.7); however, certain TAVR-specific RSMs such as the in-hospital STS/ACC TVT (C-statistic=0.65) and STT (C-statistic=0.66) predicted individual mortality more reliably than surgical models (C-statistic range=0.59-0.61). A good calibration was demonstrated by the in-hospital STS/ACC TVT (OER=0.99), 30-day STS/ACC TVT (OER=1.08) and STS (OER=1.01) models. Baseline dialysis (OER: 2.64 [1.88, 3.70]; p<0.001) was the strongest predictor of mortality. Conclusions: This study demonstrates that the STS/ACC TVT model (in-hospital and 30-day) and the STS model have accurate calibration, making them useful for comparison of centre-level risk-adjusted mortality. In contrast, the discriminative ability of currently available models is limited.

Original languageEnglish (US)
Pages (from-to)1497-1505
Number of pages9
JournalEuroIntervention
Volume15
Issue number17
DOIs
StatePublished - Apr 2020

Keywords

  • Aortic stenosis
  • Death
  • TAVI

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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