Race-Specific Impact of Conventional Surgical Risk Score on 1-Year Mortality After Transcatheter Aortic Valve Replacement

Hoyun Kim, Do Yoon Kang, Jung Min Ahn, Juyong Brian Kim, Alan C. Yeung, Takeshi Nishi, William F. Fearon, Eric P. Cantey, James D. Flaherty, Charles J. Davidson, S. Christopher Malaisrie, Nayoung Kim, Mijin Kim, Jinho Lee, Jinsun Park, Yeonwoo Choi, Seung Jung Park, Duk Woo Park*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

1 Scopus citations

Abstract

Background: Interracial differences in the distribution and prognostic value of conventional Society of Thoracic Surgeons (STS) score on long-term mortality after transcatheter aortic valve replacement (TAVR) are uncertain. Objectives: This study aims to compare the impact of STS scores on clinical outcomes at 1-year after TAVR between Asian and non-Asian populations. Methods: We used the Trans-Pacific TAVR (TP-TAVR) registry, a multinational multicenter, observational registry involving patients undergoing TAVR at 2 major centers in the United States and 1 major center in Korea. Patients were classified into 3 groups (low, intermediate, and high-risk) according to the STS score and compared between STS risk groups and race. The primary outcome was all-cause mortality at 1-year. Results: Among 1,412 patients, 581 were Asian and 831 were non-Asian. The distribution of the STS risk score group was different between Asian and non-Asian groups (62.5% low-, 29.8% intermediate-, and 7.7% high-risk in Asian vs 40.6% low-, 39.1% intermediate-, and 20.3% high-risk in non-Asian). In the Asian population, the all-cause mortality at 1-year was substantially higher in the high-risk STS group than in the low- and intermediate-risk groups (3.6% low-risk, 8.7% intermediate-risk, and 24.4% high-risk; log-rank P < 0.001), which was primarily driven by noncardiac mortality. In the non-Asian group, there was a proportional increase in all-cause mortality at 1-year according to the STS risk category (5.3% low-risk, 12.6% intermediate-risk, and 17.8% high-risk; log-rank P < 0.001).

Original languageEnglish (US)
Pages (from-to)376-387
Number of pages12
JournalJACC: Asia
Volume3
Issue number3
DOIs
StatePublished - Jun 2023

Funding

The TP-TAVR registry contains data from a multinational, multicenter, observational cohort study that included all consecutive patients with symptomatic severe AS who underwent TAVR at 2 major academic medical centers in the United States (Stanford University School of Medicine, Stanford, California, and the Feinberg School of Medicine at Northwestern University, Chicago, Illinois) and 1 in South Korea (Asan Medical Center, Seoul) ( NCT03826264 ). 20 , 21 Beginning in February 2019, data were retrospectively collected for cases performed before initiation and prospectively thereafter. Each center’s institutional review board or ethics committee approved the registry protocol. The TP-TAVR registry was partly funded by the CardioVascular Research Foundation (Seoul, Korea) and a supporting grant (2020IF0016) from the Asan Institute for Life Sciences and Corporate Relations of Asan Medical Center, Seoul, South Korea.

Keywords

  • Society of Thoracic Surgeons score
  • aortic valve stenosis
  • mortality
  • transcatheter aortic valve replacement

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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