A Novel Clinical Prediction Rule for 30-day Mortality Following Balloon Aortic Valuloplasty: The CRRAC the AV Score

Objectives: We seek to identify predictors of 30-day mortality after balloon aortic valvuloplasty (BAV). Background: To date, there is no validated method of predicting patient outcomes after percutaneous aortic valve interventions. Methods: Data for consecutive patients with severe aortic stenosis who underwent BAV at the Mount Sinai Medical Center from January 2001 to July 2007 were retrospectively reviewed. Cox-proportional hazards regression was used to identify significant predictors of 30-day mortality, and the resultant model was compared to the EuroSCORE using Akaike's Information Criterion and area under the receiver-operating curve (AUC). Results: The analysis included 281 patients (age 83 +/- 9 years, 61% women, aortic valve area: 0.64 +/- 0.2 cm(2)) and 36 (12.8%) of whom died within 30 days of BAV. With identified risk factors for 30-day mortality, critical status, renal dysfunction, right atrial pressure, and cardiac output, we constructed the CRRAC the AV risk score. Thirty-day survival was 72% in the highest tertile versus 94% in the lower two tertiles of the score. Compared to the additive and logistic EuroSCORE, the risk score demonstrated superior discrimination (AUC = 0.75 vs. 0.60 and 0.63, respectively). Conclusion: We derived a risk score, the CRRAC the AV score that identifies patients at high-risk of 30-day mortality after BAV. Validation of the developed risk prediction score, the CRRAC the AV score, is needed in other cohorts of post-BAV patients and potentially in patients undergoing other catheter-based valve interventions. (C) 2011 Wiley-Liss, Inc.