Validation of STS/ACC TVT-TAVR Score in Veterans Undergoing Transcatheter Aortic Valve Replacement

BACKGROUND: The Society of Thoracic Surgeons (STS)/American College of Cardiology (ACC) transcatheter valve therapy (TVT) transcatheter aortic valve replacement (TAVR) score was developed to predict in-hospital mortality in patients undergoing commercial TAVR in the United States. Veterans Affairs (VA) hospitals are not included in the TVT registry. METHODS: The STS/ACC TVT-TAVR score was estimated in 195 veterans undergoing TAVR from 2015-2017. Discrimination was estimated by calculating the area under the receiver operating characteristics curve (AUC) for two outcomes of interest: in-hospital and 30-day mortality. The cohort was then divided into quartiles of TAVR and STS predicted risk of mortality (PROM) scores and long-term mortality was assessed with Kaplan-Meier curves. RESULTS: The mean age of the cohort was 77 ± 8 years and the population was 99% males. The median TAVR and STS-PROM risk scores were 3.1 (interquartile range [IQR], 2.1-5.1) and 4.5 (IQR, 2.6-7.4), respectively. Observed in-hospital and 30-day mortality rates were 2.6% and 4.6%, respectively. The AUCs for the TAVR risk score were 0.68 and 0.64 for in-hospital and 30-day mortality, respectively. During a mean follow-up period of 1.9 years, a total of 37 patients (20%) died. Long-term survival was similar in different quartiles of STS-PROM scores (P≤.52). In contrast, patients in the highest quartile of TAVR risk score (8.4; IQR, 5.8-9.9) had significantly worse survival (P<.01). This group included 20 out of the 37 deaths (>50%). CONCLUSIONS: Developed and validated in commercial United States cases, the TAVR risk score has a similar performance in the veteran population for predicting short-term outcomes. In addition, the TAVR score predicts long-term mortality. Our results have implications for optimal patient selection.