Clinical Factors and Outcomes When Real-World Heart Teams Overruled STS Risk Scores in TAVR Cases
Table 1
Baseline demographic and clinical characteristics by study groups. Blank responses in the SAVR group represent data not collected in STS Adult Cardiac Surgery Database.
TAVR
TAVR
SAVR
value (TAVR, STS PROM > 3% vs. ≤3%)
value (STS PROM ≤ 3%, TAVR vs. SAVR)
STS PROM ≤ 3% (N = 415)
STS PROM > 3% (N = 2,711)
STS PROM ≤ 3% (N = 1,438)
STS PROM %, mean ± SD
2.3 ± 0.5
7.2 ± 4.2
1.4 ± 0.7
<0.001
<0.001
STS PROM %, median (IQR)
2.3 (1.9–2.7)
6.0 (4.4–8.6)
1.3 (0.9–1.9)
<0.001
<0.001
Age, mean ± SD
74.4 ± 8.6
82.2 ± 8.4
64.4 ± 11.8
<0.001
<0.001
Male, N (%)
289 (69.6%)
1385 (51.1%)
943 (65.6%)
<0.001
0.123
BSA, median (IQR)
2.0 (1.8–2.1)
1.9 (1.7–2.0)
2.0 (1.9–2.2)
<0.001
0.231
BMI, median (IQR)
28.4 (25.2–34.1)
27.1 (23.7–31.9)
29.1 (25.6–33.2)
<0.001
0.400
Race Caucasian, N (%)
395 (95.2%)
2575 (95.0%)
1305 (92.4%)
0.864
0.052
Permanent pacemaker, N (%)
33 (8.0%)
390 (14.4%)
38 (2.6%)
<0.001
<0.001
Prior ICD, N (%)
6 (1.4%)
93 (3.4%)
11 (0.8%)
0.031
0.200
Prior PCI, N (%)
128 (30.8%)
986 (36.4%)
113 (7.9%)
0.028
<0.001
Prior CABG, N (%)
53 (12.8%)
608 (22.4%)
33 (2.3%)
<0.001
<0.001
Previous AV replacement, N (%)
30 (7.2%)
153 (5.6%)
59 (4.1%)
0.202
0.009
Prior stroke, N (%)
67 (16.1%)
346 (12.8%)
81 (5.6%)
0.059
<0.001
Prior PAD, N (%)
106 (25.5%)
909 (33.5%)
85 (5.9%)
0.001
<0.001
Current/recent smoker, N (%)
39 (9.4%)
163 (6.0%)
142 (9.9%)
0.009
0.761
Hypertension, N (%)
342 (82.4%)
2407 (88.8%)
1039 (72.3%)
<0.001
<0.001
Diabetes, N (%)
118 (28.5%)
1097 (40.5%)
303 (21.1%)
<0.001
0.001
GFR, median (IQR)
77.5 (62.4–97.0)
58.3 (43.5–74.3)
81.3 (68.8–94.1)
<0.001
0.011
Currently on dialysis, N (%)
1 (0.2%)
125 (4.6%)
4 (0.3%)
<0.001
>0.999
Chronic lung disease, moderate/severe, N (%)
52 (12.6%)
599 (22.2%)
30 (2.1%)
<0.001
<0.001
Home oxygen, N (%)
25 (6.0%)
300 (11.1%)
7 (0.5%)
0.002
<0.001
Hostile chest, N (%)
41 (9.9%)
174 (6.4%)
0.009
Immunocompromise present, N (%)
37 (8.9%)
374 (13.8%)
49 (3.4%)
0.006
<0.001
Prior MI, N (%)
77 (18.6%)
639 (23.6%)
102 (7.1%)
0.023
<0.001
NYHA class III or IV within 2 weeks, N (%)
253 (61.6%)
2006 (74.3%)
233 (16.2%)
<0.001
<0.001
Calcified/atherosclerotic aorta, N (%)
36 (8.7%)
112 (4.1%)
20 (1.4%)
<0.001
<0.001
Left ventricle ejection fraction (%), median (IQR)
61.0 (55.0–65.0)
60.0 (45.0–65.0)
61.0 (58.0–65.0)
<0.001
0.961
Atrial fibrillation/flutter, N (%)
125 (30.1%)
1201 (44.4%)
141 (10.1%)
<0.001
<0.001
Five-meter walk time (sec), median (IQR)
6.7 (5.0–8.0)
7.7 (6.0–9.7)
5.0 (4.0–5.3)
<0.001
<0.001
AV peak velocity m/sec, median (IQR)
4.2 (3.8–4.5)
4.1 (3.6–4.5)
0.002
AV peak gradient mmHg, median (IQR)
70.0 (58.0–83.0)
67.0 (53.0–80.0)
0.001
AV annulus diameter size (mm), median (IQR)
24.0 (22.0–26.0)
23.0 (21.0–25.0)
<0.001
Smallest AV area (cm2), median (IQR)
0.8 (0.6–0.9)
0.7 (0.6–0.8)
0.8 (0.7–0.9)
<0.001
0.106
AV mean gradient mmHg, median (IQR)
42.0 (36.0–51.8)
40.0 (31.0–49.0)
45.0 (38.0–55.0)
<0.001
<0.001
AV morphology bicuspid, N (%)
28 (6.8%)
66 (2.4%)
<0.001
MV regurgitation, moderate/severe, N (%)
56 (13.5%)
672 (24.9%)
114 (8.0%)
<0.001
0.001
Blank responses in the SAVR group represent data not collected in STS Adult Cardiac Surgery Database. Abbreviations: IQR=interquartile range; SD=standard deviation; STS PROM=predicted risk of mortality for surgical aortic valve replacement based on the Society for Thoracic Surgeon’s risk model; BSA=body surface area; BMI=body mass index; ICD=implantable cardioverter defibrillator; CABG=coronary artery bypass graft; AV=aortic valve; PAD=peripheral arterial disease; GFR=glomerular filtration rate; MI=myocardial infarction; NYHA=New York Heart Association; MV=mitral valve.
