Martin, G, Sperrin, M, Ludman, P, Debelder, M, Redwood, S, Townend, J, Gunning, M, Moat, N, Banning, A, Buchan, I and Mamas, M ORCID: 0000-0001-9241-8890 (2017) A Novel UK Prognostic Model for 30-day Mortality following Transcatheter Aortic Valve Implantation. Heart, 104 (13). pp. 1109-1116. ISSN 1468-201X

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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.

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.

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.

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.

Item Type: Article
Additional Information: This is the accepted author manuscript (AAM). The final published version (version of record) will be available online via BMJ at http://dx.doi.org/10.1136/heartjnl-2017-312489- please refer to any applicable terms of use of the publisher.
Uncontrolled Keywords: Aortic stenosis, transcatheter aortic valve implantation, risk model, clinical prediction model, mortality
Subjects: R Medicine > RC Internal medicine > RC666 Diseases of the circulatory (Cardiovascular) system
Divisions: Faculty of Medicine and Health Sciences > Institute for Science and Technology in Medicine
Depositing User: Symplectic
Date Deposited: 22 Nov 2017 14:42
Last Modified: 28 Aug 2018 13:48
URI: http://eprints.keele.ac.uk/id/eprint/4262

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