Study Analyzes Predictive Value of EuroSCOREs in TAVR

January 29, 2019–Online in Circulation: Cardiovascular Interventions, Giuseppe Tarantini, MD, et al published findings from an evaluation of 1-year outcomes according to surgical risk in the transcatheter aortic valve replacement (TAVR) cohort of the European SOURCE 3 registry, which is evaluating patients with severe aortic stenosis treated with the commercially available Sapien 3 transcatheter heart valve (Edwards Lifesciences).

In this subanalysis of the prospective SOURCE 3 registry, the investigators aimed to assess the distribution of surgical risk score categories in current clinical practice and their relationship with clinical outcomes and the calibration and discrimination power of both the logistic EuroSCORE (logES) and EuroSCORE II.

As summarized in Circulation: Cardiovascular Interventions, the investigators reported that out of 1,785 patients, 518 patients (low surgical risk) had a baseline logES < 10%; 691 patients (intermediate surgical risk) had a logES 10% to 20%; and only 576 patients (high surgical risk) had a logES ≥ 20%. Even if low-risk patients were younger compared with the other groups, the mean age was approximately 80 years in each risk category.

The investigators found that at 1 year, all-cause mortality was 10.3%, 11.4%, and 17.1% in low-, intermediate-, and high-surgical-risk patients, respectively; cardiac mortality was 5.3%, 7.7%, and 11.4%, respectively.

Observed mortality rates were substantially lower than that predicted with logES. The observed/predicted mortality ratio was 0.26 in low-surgical-risk patients, 0.08 in intermediate-surgical-risk patients, and 0.12 in high-surgical-risk patients. Similar observations were obtained with EuroSCORE II.

In this real-world setting, two-thirds of patients treated with the Sapien 3 TAVR device had a logES < 20% but were still considered appropriate TAVR candidates by the heart team, mainly because of older age and less frequently because of conditions not captured by risk scores. The logES and EuroSCORE II had poor discrimination and calibration power in this TAVR cohort concluded the investigators in Circulation: Cardiovascular Interventions.