TY - JOUR
T1 - Systematic review and meta-analysis of current risk models in predicting short-term mortality after transcatheter aortic valve replacement
AU - Siddiqi, Tariq Jamal
AU - Usman, Muhammad Shariq
AU - Khan, Muhammad Shahzeb
AU - Khan, Muhammad Arbaz Arshad
AU - Riaz, Haris
AU - Khan, Safi U.
AU - Murad, M. Hassan
AU - Kavinsky, Clifford J.
AU - Doukky, Rami
AU - Kalra, Ankur
AU - Desai, Milind Y.
AU - Bhatt, Deepak L.
N1 - Publisher Copyright:
© Europa Digital & Publishing 2020.
PY - 2020/4
Y1 - 2020/4
N2 - 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.
AB - 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.
KW - Aortic stenosis
KW - Death
KW - TAVI
UR - http://www.scopus.com/inward/record.url?scp=85083394459&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85083394459&partnerID=8YFLogxK
U2 - 10.4244/EIJ-D-19-00636
DO - 10.4244/EIJ-D-19-00636
M3 - Review article
C2 - 31659984
AN - SCOPUS:85083394459
SN - 1774-024X
VL - 15
SP - 1497
EP - 1505
JO - EuroIntervention
JF - EuroIntervention
IS - 17
ER -