Clinical value of the 20% logistic EuroSCORE cut-off for selecting TAVI candidates: a single-centre cohort study analysis
BackgroundA 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 pat...
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doaj-d598065c06514642a68538dacd1909bc2020-12-14T14:46:11ZengBMJ Publishing GroupOpen Heart2053-36242020-06-017110.1136/openhrt-2019-001194Clinical value of the 20% logistic EuroSCORE cut-off for selecting TAVI candidates: a single-centre cohort study analysisGuram Imnadze0Steffen Hofmann1Michael Billion2Abbas Ferdosi3Marek Kowalski4Ehab Rajab5Karin Bramlage6Henning Warnecke7Norbert Franz8Institut für Gesundheitsforschung und Bildung, Universität Osnabrück, Osnabrück, GermanyDepartment of Cardiac Surgery, Schüchtermann Clinic, Bad Rothenfelde, GermanyDepartment of Cardiac Surgery, Schüchtermann Clinic, Bad Rothenfelde, GermanyDepartment of Cardiac Surgery, Schüchtermann Clinic, Bad Rothenfelde, GermanyDepartment of Cardiology, Schüchtermann Clinic, Bad Rothenfelde, GermanyDepartment of Cardiac Surgery, Schüchtermann Clinic, Bad Rothenfelde, GermanyInstitute for Pharmacology and Preventive Medicine, Cloppenburg, GermanyDepartment of Cardiac Surgery, Schüchtermann Clinic, Bad Rothenfelde, GermanyDepartment of Cardiology, Schüchtermann Clinic, Bad Rothenfelde, GermanyBackgroundA 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.MethodsWe 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.Results1679 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).ConclusionsAt 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.https://openheart.bmj.com/content/7/1/e001194.full |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Guram Imnadze Steffen Hofmann Michael Billion Abbas Ferdosi Marek Kowalski Ehab Rajab Karin Bramlage Henning Warnecke Norbert Franz |
spellingShingle |
Guram Imnadze Steffen Hofmann Michael Billion Abbas Ferdosi Marek Kowalski Ehab Rajab Karin Bramlage Henning Warnecke Norbert Franz Clinical value of the 20% logistic EuroSCORE cut-off for selecting TAVI candidates: a single-centre cohort study analysis Open Heart |
author_facet |
Guram Imnadze Steffen Hofmann Michael Billion Abbas Ferdosi Marek Kowalski Ehab Rajab Karin Bramlage Henning Warnecke Norbert Franz |
author_sort |
Guram Imnadze |
title |
Clinical value of the 20% logistic EuroSCORE cut-off for selecting TAVI candidates: a single-centre cohort study analysis |
title_short |
Clinical value of the 20% logistic EuroSCORE cut-off for selecting TAVI candidates: a single-centre cohort study analysis |
title_full |
Clinical value of the 20% logistic EuroSCORE cut-off for selecting TAVI candidates: a single-centre cohort study analysis |
title_fullStr |
Clinical value of the 20% logistic EuroSCORE cut-off for selecting TAVI candidates: a single-centre cohort study analysis |
title_full_unstemmed |
Clinical value of the 20% logistic EuroSCORE cut-off for selecting TAVI candidates: a single-centre cohort study analysis |
title_sort |
clinical value of the 20% logistic euroscore cut-off for selecting tavi candidates: a single-centre cohort study analysis |
publisher |
BMJ Publishing Group |
series |
Open Heart |
issn |
2053-3624 |
publishDate |
2020-06-01 |
description |
BackgroundA 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.MethodsWe 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.Results1679 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).ConclusionsAt 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. |
url |
https://openheart.bmj.com/content/7/1/e001194.full |
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