Clinical value of the 20% logistic EuroSCORE cut-off for selecting TAVI candidates: a single-centre cohort study analysis

Autor(en): Imnadze, Guram
Hofmann, Steffen
Billion, Michael
Ferdosi, Abbas
Kowalski, Marek
Rajab, Ehab
Bramlage, Karin
Bramlage, Peter
Warnecke, Henning
Franz, Norbert
Stichwörter: AORTIC-VALVE IMPLANTATION; Cardiac & Cardiovascular Systems; CARDIOLOGY ESC; Cardiovascular System & Cardiology; CORONARY-ARTERY DISEASE; EUROPEAN-ASSOCIATION; PACEMAKER IMPLANTATION; PERMANENT PACEMAKER; REPLACEMENT; RISK-STRATIFICATION; SCORE; TRANSCATHETER
Erscheinungsdatum: 2020
Herausgeber: BMJ PUBLISHING GROUP
Journal: OPEN HEART
Volumen: 7
Ausgabe: 1
Zusammenfassung: 
Background A logistic European System for Cardiac Operative Risk Evaluation (logEuroSCORE) >= 20% is frequently recognised as a finite criteria for transcatheter aortic valve implantation (TAVI) reimbursement, despite guideline modifications to reflect the appropriacy of TAVI in selected lower-risk patients. The aim was to evaluate the clinical value of this threshold cut-off in TAVI patients and to identify factors associated with mortality in those below this threshold. Methods We analysed data from a single-centre, German, observational, TAVI-patient registry, gathered between 2008 and 2016. Patients were stratified by logEuroSCORE (>= or <20%) for comparisons. Logistic regression was performed to identify predictors of mortality at 1 year, with this analysis used to generate a calculated ('real') risk value for each patient. Results 1679 patients (logEuroSCORE <20%: n=789; logEuroSCORE >= 20%: n=890) were included. LogEuroSCORE <20% patients were significantly younger (80.1 vs 81.6 years; p<0.001) and less comorbid than logEuroSCORE >= 20% patients, with a higher rate of transfemoral TAVI (35.6% vs 26.1%; p<0.001) and predilation (70.0% vs 63.3%; p=0.004). Patients with a logEuroSCORE <20% experienced more vascular complications (3.4% vs 1.5%; p=0.010). One-year survival was 88.3% in the logEuroSCORE <20% and 81.8% in the logEuroSCORE >= 20% group (p=0.005), with the calculated mortality risk falling within 2% of the logEuroSCORE in just 12.9% of patients. In the logEuroSCORE <20% group, only coronary artery disease was significantly predictive of 1-year mortality (OR 2.408; 95% CI 1.361 to 4.262; p=0.003). Conclusions At our institution, patients with a logEuroSCORE <20% selected for TAVI have excellent outcomes. The decision not to reimburse TAVI in such patients may be viewed as inappropriate.
ISSN: 20533624
DOI: 10.1136/openhrt-2019-001194

Show full item record

Google ScholarTM

Check

Altmetric