External validation of existing prediction models of 30-day mortality after Transcatheter Aortic Valve Implantation (TAVI) in the Netherlands Heart Registration. (15th October 2020)

• Record Type: Journal Article
• Authors: Al-Farra, Hatem; Abu-Hanna, Ameen; de Mol, Bas A.J.M.; ter Burg, W.J.; Houterman, Saskia; Henriques, José P.S.; Ravelli, Anita C.J.; Vis, M.M.; Vos, J.; Ten Berg, J.; Tonino, W.A.L.; Schotborgh, C.E.; Roolvink, V.; Porta, F.; Stoel, M.; Kats, S.; Amoroso, G.; van der Werf, H.W.; Stella, P.R.; de Jaegere, P.
• Is Part Of: International journal of cardiology. Volume 317(2020)
• Page Start: 25
• Page End: 32
• Publication Date: 2020-10-15
• Subjects: Transcatheter aortic valve implantation (TAVI) -- Mortality -- Prediction model -- External validation -- Discrimination -- Calibration; NHR Netherlands Heart Registration ("Nederlandse Hart Registratie in Dutch") -- Amsterdam UMC Amsterdam University Medical Center - location AMC (Academic Medical Center) -- MPM Mortality Prediction Models -- TAVI (TAVR) Transcatheter Aortic Valve Implantation (Replacement) -- SAVR Surgical Aortic Valve Replacement -- EuroSCORE European System for Cardiac Operative Risk Evaluation -- STS-PRoM (STS) Society of Thoracic Surgeons Predicted Risk of Mortality -- OBSERVANT Observational Study Of Appropriateness, Efficacy, And Effectiveness of AVR-TAVR Procedures For the Treatment Of Severe Symptomatic Aortic Stenosis [14] -- FRANCE-2 French Aortic National CoreValve and Edwards [15] -- ACC-TAVI (ACC TVT) American College of Cardiology Transcatheter Valve Therapy -- German-AV German Aortic Valve Score -- AU-ROC Area Under the Receiver Operating-Characteristic Curve -- AU-PRC Area Under the Precision-Recall Curve -- BSS Brier Skill Score -- LVEF Left Ventricular Ejection Fraction -- NYHA New York Heart Association; Cardiology -- Periodicals; Electronic journals; 616.12
• DOI: 10.1016/j.ijcard.2020.05.039
• Languages: English
• ISSNs: 0167-5273

Abstract

Abstract: Background: Several mortality prediction models (MPM) are used for predicting early (30-day) mortality following transcatheter aortic valve implantation (TAVI). Little is known about their predictive performance in external TAVI populations. We aim to externally validate established MPMs on a large TAVI dataset from the Netherlands Heart Registration (NHR). Methods: We included data from NHR-patients who underwent TAVI during 2013–2017. We calculated the predicted mortalities per MPM. We assessed the predictive performance by discrimination (Area Under Receiver Operating-characteristic Curve, AU-ROC); the Area Under Precision-Recall Curve, AU-PRC; calibration (using calibration-intercept and calibration-slope); Brier Score and Brier Skill Score. We also assessed the predictive performance among subgroups: tertiles of mortality-risk for non-survivors, gender, and access-route. Results: We included 6177 TAVI-patients with an observed early-mortality rate of 4.5% ( n = 280). We applied seven MPMs (STS, EuroSCORE-I, EuroSCORE-II, ACC-TAVI, FRANCE-2, OBSERVANT, and German-AV) on our cohort. The highest AU-ROCs were 0.64 (95%CI 0.61–0.67) for ACC-TAVI and 0.63 (95%CI 0.60–0.67) for FRANCE-2. All MPMs had a very low AU-PRC of ≤0.09. ACC-TAVI had the best calibration-intercept and calibration-slope. Brier Score values ranged between 0.043 and 0.063. Brier Skill Score ranged between −0.47 and 0.004. ACC-TAVI and FRANCE-2 predicted high mortality-risk better than other MPMs. ACC-TAVI outperformed other MPMs in different subgroups. Conclusion: The ACC-TAVI model has relatively the best predictive performance. However, all models have poor predictive performance. Because of the poor discrimination, miscalibration and limited accuracy of the models there is a need to update the existing models or develop new TAVI-specific models for local populations. Highlights: Existing MPMs have different ability in predicting early-mortality after TAVI. Existing MPMs had poor predictive performance in external TAVI population. Using such MPMs outside the original population is questionable. Developing TAVI-specific MPM (preferably global model) is a need.