Relationship between the logistic EuroSCORE and the Society of Thoracic Surgeons Predicted Risk of Mortality score in patients implanted with the CoreValve ReValving system--a Bern-Rotterdam Study

Background Surgical risk scores, such as the logistic EuroSCORE (LES) and Society of Thoracic Surgeons Predicted Risk of Mortality (STS) score, are commonly used to identify high-risk or “inoperable” patients for transcatheter aortic valve implantation (TAVI). In Europe, the LES plays an important role in selecting patients for implantation with the Medtronic CoreValve System. What is less clear, however, is the role of the STS score of these patients and the relationship between the LES and STS. Objective The purpose of this study is to examine the correlation between LES and STS scores and their performance characteristics in high-risk surgical patients implanted with the Medtronic CoreValve System. Methods All consecutive patients (n = 168) in whom a CoreValve bioprosthesis was implanted between November 2005 and June 2009 at 2 centers (Bern University Hospital, Bern, Switzerland, and Erasmus Medical Center, Rotterdam, The Netherlands) were included for analysis. Patient demographics were recorded in a prospective database. Logistic EuroSCORE and STS scores were calculated on a prospective and retrospective basis, respectively. Results Observed mortality was 11.1%. The mean LES was 3 times higher than the mean STS score (LES 20.2% ± 13.9% vs STS 6.7% ± 5.8%). Based on the various LES and STS cutoff values used in previous and ongoing TAVI trials, 53% of patients had an LES ≥15%, 16% had an STS ≥10%, and 40% had an LES ≥20% or STS ≥10%. Pearson correlation coefficient revealed a reasonable (moderate) linear relationship between the LES and STS scores, r = 0.58, P < .001. Although the STS score outperformed the LES, both models had suboptimal discriminatory power (c-statistic, 0.49 for LES and 0.69 for STS) and calibration. Conclusions Clinical judgment and the Heart Team concept should play a key role in selecting patients for TAVI, whereas currently available surgical risk score algorithms should be used to guide clinical decision making.

Report of a European Society of Cardiology-European Association of Percutaneous Cardiovascular Interventions task force on the evaluation of coronary stents in Europe: executive summary.

The evaluation for European Union market approval of coronary stents falls under the Medical Device Directive that was adopted in 1993. Specific requirements for the assessment of coronary stents are laid out in supplementary advisory documents. In response to a call by the European Commission to make recommendations for a revision of the advisory document on the evaluation of coronary stents (Appendix 1 of MEDDEV 2.7.1), the European Society of Cardiology (ESC) and the European Association of Percutaneous Cardiovascular Interventions (EAPCI) established a Task Force to develop an expert advisory report. As basis for its report, the ESC-EAPCI Task Force reviewed existing processes, established a comprehensive list of all coronary drug-eluting stents that have received a CE mark to date, and undertook a systematic review of the literature of all published randomized clinical trials evaluating clinical and angiographic outcomes of coronary artery stents between 2002 and 2013. Based on these data, the TF provided recommendations to inform a new regulatory process for coronary stents. The main recommendations of the task force include implementation of a standardized non-clinical assessment of stents and a novel clinical evaluation pathway for market approval. The two-stage clinical evaluation plan includes recommendation for an initial pre-market trial with objective performance criteria (OPC) benchmarking using invasive imaging follow-up leading to conditional CE-mark approval and a subsequent mandatory, large-scale randomized trial with clinical endpoint evaluation leading to unconditional CE-mark. The data analysis from the systematic review of the Task Force may provide a basis for determination of OPC for use in future studies. This paper represents an executive summary of the Task Force's report.

Proceedings of the Royal Society of London.

Title on vol. t.p., 1905-1934: Proceedings of the Royal Society of London. Series B, Containing papers of a biological character.

Alcohol; as a food and medicine. A paper from the Transactions of the International medical congress, at Philadelphia, September, 1876.

Mode of access: Internet.

Report of the Committee appointed by the Philomathean Society of the University of Pennsylvania to translate the inscription on the Rosetta stone.

The "Report" includes the hieroglyphic text, translations of the three texts, and an essay on Ptolemee Epiphanes. The "Appendix" contains a facsimile of the demotic text and the Greek text.

A list of the fellows & honorary, foreign, & corresponding members & medallists of the Zoological society of London. Corrected to May 31st, 1922.

Mode of access: Internet.

A Life of John Colet, D.D. : dean of St. Paul's and founder of St. Paul's school ; with an appendix of some of his English writings /

Includes index.

The registry of St. Mary, Leicester, in the county of Leicester.

Mode of access: Internet.

Transactions of the American Society of Civil Engineers.

Vols. 29-30 include papers of the International Engineering Congress, Chicago, 1893; v. 54 includes papers of the International Engineering Congress, St. Louis, 1904.

Writings of the Rev. John Bradford : prebendary of St. Paul's, and martyr, A.D.1555.

Some account of the Rev. John Bradford: p.[ix]-xxvi.

The well child : a Christmas offering to the children of St. Luke's church, Rochester /

Little Daniel, the good boy: who died in Springfield, Mass.: has separate t.-p.

The diary of Dr. Thomas Cartwright, bishop of Chester; commencing at the time of his elevation to that see, August M.DC.LXXXVI,; and terminating with the visitation of St. Mary Magdalene college, Oxford, October M.DC.LXXXVII.

Mode of access: Internet.

The history of modern Europe. With an account of the decline and fall of the Roman empire: and a view of the progress of society, from the rise of the modern kingdoms to the peace of Paris, in 1763.

Vols. 2 and 4 printed by Robert Carr; v. 3 by John Bioren.