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In the presented study, the EuroSCORE II and STS calculators showed a significantly better discrimination ability to predict both 30-day mortality as well as 1-year compared to the EuroSCORE calculator. On the other hand, discriminatory abilities of EuroSCORE II calculators and STS did not differ significantly between themselves. The calibration capacity, i.e., the correspondence between the predicted and observed mortality, was the closest when using the EuroSCORE II calculator (3.0% vs. 2.9%), compared to the STS (2.1%) model. Thus, the results of the presented study indicate satisfactory discrimination and calibration of the EuroSCORE II and STS calculator in the group of patients with aortic stenosis undergoing valve replacement by the classical method. It seems that in Polish conditions, the EuroSCORE II or STS calculator should be the tool of choice for assessing the risk of death in patients with severe aortic stenosis qualified for AVR. However, it is worth noting that the available risk calculators do not allow accurate estimation of perioperative mortality due to insufficient calibration and discrimination (10). Accurate qualification for surgical treatment of valvular heart disease seems to be important also due to the development of new alternative treatments for heart disease, such as TAVI, for patients with medium or high risk of surgery (13). Therefore, it seems reasonable to put forward the thesis that our knowledge about predictors requires supplementation and, therefore, further research, in order to better calibrate and discriminate against the anticipated risk. Based on the research carried out so far, it seems that biomarkers such as RDW, RBC, Troponin T or frailty may be useful in improving discrimination against the EuroSCORE II calculator (14-19). Moreover, it is worth noting that when qualifying a patient for cardiac surgery, it is necessary to assess the therapeutic resources of a given center (including staff training), the results of postoperative treatment and the results of percutaneous intervention (6,20). The decision to treat cardiac surgery should be made after a detailed analysis of experts (hearteam), in consultation with the patient and his family, in order to choose the most optimal type of therapy (21,22).
The original European System for Cardiac Operative Risk Evaluation (EuroSCORE) has been recently updated as EuroSCORE II to optimize its efficacy in cardiac surgery, but its performance has been poorly evaluated for predicting 30-day mortality in patients who undergo transcatheter aortic valve replacement (TAVR). Consecutive patients (n = 250) treated with TAVR were included in this analysis. Transapical access was used in 60 patients, while 190 procedures were performed using a transfemoral approach. Calibration (risk-adjusted mortality ratio) and discrimination (C-statistic and U-statistic) were calculated for the logistic EuroSCORE, EuroSCORE II, and Society of Thoracic Surgeons (STS) scores for predicting 30-day mortality. Observed mortality was 7.6% in the overall population (6.3% and 11.7% for the transfemoral and transapical cohorts, respectively). Predicted mortality was 22.6 12.8% by logistic EuroSCORE, 7.7 5.8% by EuroSCORE II, and 7.3 4.1% by STS score. The risk-adjusted mortality ratio was 0.34 (95% confidence interval [CI] 0.10 to 0.58) for logistic EuroSCORE, 0.99 (95% CI 0.29 to 1.69) for EuroSCORE II, and 1.05 (95% CI 0.30 to 1.79) for STS score. Moderate discrimination was observed with EuroSCORE II (C-index 0.66, 95% CI 0.52 to 0.79, p = 0.02) compared to the logistic EuroSCORE (C-index 0.63, 95% CI 0.51 to 0.76, p = 0.06) and STS (C-index 0.58, 95% CI 0.43 to 0.73, p = 0.23) score, without a significant difference among the 3 risk scores. Discrimination was slightly better in the transfemoral cohort compared to the transapical cohort with the 3 risk scores. In conclusion, EuroSCORE II and the STS score are better calibrated than the logistic EuroSCORE but have moderate discrimination for predicting 30-day mortality after TAVR.
In the study, the perioperative risk estimated with the ESL and the ESII risk scores was compared with a real-life outcome among over 500 patients. Regardless of the type of surgery, result in the ESL was better correlated with the risk of in-hospital death. 153554b96e