Back to Search
Start Over
Novel United Kingdom prognostic model for 30-day mortality following transcatheter aortic valve implantation.
- Source :
-
Heart (British Cardiac Society) [Heart] 2018 Jul; Vol. 104 (13), pp. 1109-1116. Date of Electronic Publication: 2017 Dec 07. - Publication Year :
- 2018
-
Abstract
- Objective: Existing clinical prediction models (CPM) for short-term mortality after transcatheter aortic valve implantation (TAVI) have limited applicability in the UK due to moderate predictive performance and inconsistent recording practices across registries. The aim of this study was to derive a UK-TAVI CPM to predict 30-day mortality risk for benchmarking purposes.<br />Methods: A two-step modelling strategy was undertaken: first, data from the UK-TAVI Registry between 2009 and 2014 were used to develop a multivariable logistic regression CPM using backwards stepwise regression. Second, model-updating techniques were applied using the 2013-2014 data, thereby leveraging new approaches to include frailty and to ensure the model was reflective of contemporary practice. Internal validation was performed by bootstrapping to estimate in-sample optimism-corrected performance.<br />Results: Between 2009 and 2014, up to 6339 patients were included across 34 centres in the UK-TAVI Registry (mean age, 81.3; 2927 female (46.2%)). The observed 30-day mortality rate was 5.14%. The final UK-TAVI CPM included 15 risk factors, which included two variables associated with frailty. After correction for in-sample optimism, the model was well calibrated, with a calibration intercept of 0.02 (95% CI -0.17 to 0.20) and calibration slope of 0.79 (95% CI 0.55 to 1.03). The area under the receiver operating characteristic curve, after adjustment for in-sample optimism, was 0.66.<br />Conclusion: The UK-TAVI CPM demonstrated strong calibration and moderate discrimination in UK-TAVI patients. This model shows potential for benchmarking, but even the inclusion of frailty did not overcome the need for more wide-ranging data and other outcomes might usefully be explored.<br />Competing Interests: Competing interests: None declared.<br /> (© Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.)
- Subjects :
- Adult
Aged
Aged, 80 and over
Aortic Valve Stenosis diagnosis
Aortic Valve Stenosis mortality
Benchmarking
Female
Humans
Male
Middle Aged
Predictive Value of Tests
Quality Indicators, Health Care
Registries
Reproducibility of Results
Risk Assessment
Risk Factors
Time Factors
Transcatheter Aortic Valve Replacement adverse effects
Transcatheter Aortic Valve Replacement standards
Treatment Outcome
United Kingdom
Aortic Valve Stenosis surgery
Decision Support Techniques
Transcatheter Aortic Valve Replacement mortality
Subjects
Details
- Language :
- English
- ISSN :
- 1468-201X
- Volume :
- 104
- Issue :
- 13
- Database :
- MEDLINE
- Journal :
- Heart (British Cardiac Society)
- Publication Type :
- Academic Journal
- Accession number :
- 29217636
- Full Text :
- https://doi.org/10.1136/heartjnl-2017-312489