TY - JOUR
T1 - Development and validation of a prediction model for early mortality after transcatheter aortic valve implantation (TAVI) based on the Netherlands Heart Registration (NHR)
T2 - The TAVI-NHR risk model
AU - NHR THI Registration Committee
AU - Al-Farra, Hatem
AU - Ravelli, Anita C. J.
AU - Henriques, José P. S.
AU - Houterman, Saskia
AU - de Mol, Bas A. J. M.
AU - Abu-Hanna, Ameen
N1 - Funding Information: The authors have not declared a specific grant for this study from any funding agency in the public, commercial or not-for-profit sectors. Publisher Copyright: © 2022 The Authors. Catheterization and Cardiovascular Interventions published by Wiley Periodicals LLC.
PY - 2022/11/1
Y1 - 2022/11/1
N2 - Background: The currently available mortality prediction models (MPM) have suboptimal performance when predicting early mortality (30-days) following transcatheter aortic valve implantation (TAVI) on various external populations. We developed and validated a new TAVI-MPM based on a large number of predictors with recent data from a national heart registry. Methods: We included all TAVI-patients treated in the Netherlands between 2013 and 2018, from the Netherlands Heart Registration. We used logistic-regression analysis based on the Akaike Information Criterion for variable selection. We multiply imputed missing values, but excluded variables with >30% missing values. For internal validation, we used ten-fold cross-validation. For temporal (prospective) validation, we used the 2018-data set for testing. We assessed discrimination by the c-statistic, predicted probability accuracy by the Brier score, and calibration by calibration graphs, and calibration-intercept and calibration slope. We compared our new model to the updated ACC-TAVI and IRRMA MPMs on our population. Results: We included 9144 TAVI-patients. The observed early mortality was 4.0%. The final MPM had 10 variables, including: critical-preoperative state, procedure-acuteness, body surface area, serum creatinine, and diabetes-mellitus status. The median c-statistic was 0.69 (interquartile range [IQR] 0.646–0.75). The median Brier score was 0.038 (IQR 0.038–0.040). No signs of miscalibration were observed. The c-statistic's temporal-validation was 0.71 (95% confidence intervals 0.64–0.78). Our model outperformed the updated currently available MPMs ACC-TAVI and IRRMA (p value < 0.05). Conclusion: The new TAVI-model used additional variables and showed fair discrimination and good calibration. It outperformed the updated currently available TAVI-models on our population. The model's good calibration benefits preprocedural risk-assessment and patient counseling.
AB - Background: The currently available mortality prediction models (MPM) have suboptimal performance when predicting early mortality (30-days) following transcatheter aortic valve implantation (TAVI) on various external populations. We developed and validated a new TAVI-MPM based on a large number of predictors with recent data from a national heart registry. Methods: We included all TAVI-patients treated in the Netherlands between 2013 and 2018, from the Netherlands Heart Registration. We used logistic-regression analysis based on the Akaike Information Criterion for variable selection. We multiply imputed missing values, but excluded variables with >30% missing values. For internal validation, we used ten-fold cross-validation. For temporal (prospective) validation, we used the 2018-data set for testing. We assessed discrimination by the c-statistic, predicted probability accuracy by the Brier score, and calibration by calibration graphs, and calibration-intercept and calibration slope. We compared our new model to the updated ACC-TAVI and IRRMA MPMs on our population. Results: We included 9144 TAVI-patients. The observed early mortality was 4.0%. The final MPM had 10 variables, including: critical-preoperative state, procedure-acuteness, body surface area, serum creatinine, and diabetes-mellitus status. The median c-statistic was 0.69 (interquartile range [IQR] 0.646–0.75). The median Brier score was 0.038 (IQR 0.038–0.040). No signs of miscalibration were observed. The c-statistic's temporal-validation was 0.71 (95% confidence intervals 0.64–0.78). Our model outperformed the updated currently available MPMs ACC-TAVI and IRRMA (p value < 0.05). Conclusion: The new TAVI-model used additional variables and showed fair discrimination and good calibration. It outperformed the updated currently available TAVI-models on our population. The model's good calibration benefits preprocedural risk-assessment and patient counseling.
KW - aortic stenosis
KW - internal validation
KW - mortality
KW - prediction model
KW - transcatheter aortic valve implantation (TAVI)
UR - http://www.scopus.com/inward/record.url?scp=85137656077&partnerID=8YFLogxK
U2 - https://doi.org/10.1002/ccd.30398
DO - https://doi.org/10.1002/ccd.30398
M3 - Article
C2 - 36069120
SN - 1522-1946
VL - 100
SP - 879
EP - 889
JO - Catheterization and cardiovascular interventions
JF - Catheterization and cardiovascular interventions
IS - 5
ER -