The use of statistical risk models has become an integral part of cardiovascular medicine. Risk assessment for transcatheter aortic valve replacement (TAVR) is particularly challenging because of the need to predict risk for surgical aortic valve replacement as well as the risk of the TAVR procedure itself.
In the United States, Society of Thoracic Surgeons (STS) risk models are typically used to estimate surgical aortic valve replacement risk to categorize TAVR candidates into low-, intermediate-, or high-risk groups. These STS models are fully disclosed in the literature and provided to all STS database participants, thereby making them readily available for widespread use.1 As pointed out by Rogers et al,2 the models must be used carefully, with full recognition of their designed features. Temporal changes in the patient population and procedural outcomes are known to occur, so the models are frequently updated to accurately reflect these changes. As illustrated by Rogers et al,2 inaccuracies and misclassification are likely if models developed for a certain year are applied to a patient population from a different year. This clearly constitutes a misuse of the STS surgical aortic valve replacement risk models.
Edwards FH. Use of Society of Thoracic Surgeons Risk Models in the Assessment of Patients Who Underwent a Transcatheter Aortic Valve Replacement. JAMA Cardiol. 2017;2(4):456-457. doi:10.1001/jamacardio.2016.4133