Value of Emory Risk Score to Predict Permanent Pacemaker Implantation After TAVR

The Emory risk score was found to have modest value for predicting permanent pacemaker implantation, according to a study published in the Journal of Interventional Cardiology.

Data from patients (N=479) in the New York State and the Society of Thoracic Surgery (STS) databases who underwent transcatheter aortic valve replacement (TAVR) for severe aortic stenosis between 2016 and 2018 were evaluated for baseline characteristics, Emory risk score, and implantation of a permanent pacemaker.

In this cohort, 20.7% (mean age, 82.2±10.5 years; 52.5% men; 32.3% diabetes) of patients required a permanent pacemaker after TAVR. Mean age of patients who did not require pacemaker was 82.3±7.8 years (44.6% men; 32.9% with diabetes).

Patients who did vs did not require a pacemaker differed significantly in: Emory risk score (P <.001), baseline right bundle branch block (RBBB; 30.3% vs 7.7%, respectively; P <.001), and baseline QRS duration >140 ms (23.2% vs 9.2%, respectively; P <.001). Of patients who received a pacemaker, 86.9% required implantation during the index TAVR admission.

The percentages of patients receiving a self-expanding vs balloon-expandable valve were comparable (50.7% vs 49.3%, respectively). A greater percentage of patients who received a self-expanding vs balloon-expandable valve had a permanent pacemaker implanted (61.6% vs 38.4%, respectively; P =.015).

The overall predictive power of the Emory risk score was similar for balloon-expandable vs self-expanding valves (area under receiver-operating characteristic [ROC], 0.645 vs 0.657, respectively).

The 4 components of the Emory risk score were oversize >16%, baseline RBBB, baseline QRS >140 ms, and syncope history. Baseline RBBB was the only components of the Emory risk score found to independently predict pacemaker implantation (balloon-expandable: odds ratio [OR], 3.63; 95% CI, 1.31-10.05; P =.013; self-expanding: OR, 5.57; 95% CI, 2.20-14.10; P <.001).

Although baseline QRS was associated with pacemaker implantation, this association was no longer significant in the multivariate analysis (balloon-expandable: P =.270; self-expandable: P =.780).

The predictive performance of the Emory risk score was comparable with that of baseline RBBB alone (balloon-expandable: ROC, 0.615; P =.350; self-expanding: ROC, 0.615; P =.151).

Study limitations include the lack of specific guidelines on when to implant a pacemaker following TAVR. In addition, decisions of individual physicians may have introduced type II errors into these results.

“In our cohort, the Emory risk score had modest predictive utility for [permanent pacemaker] insertion after TAVR for both balloon-expandable and self-expanding prostheses. The risk score did not offer better discriminatory utility than that of preoperative RBBB alone,” concluded the study authors.

Disclosure: An author declared affiliations with industry. Please refer to the original article for a full list of disclosures.

Reference

Spring A M, Catalano M A, Prasad V, et al. Evaluating the validity of risk scoring in predicting pacemaker rates following transcatheter aortic valve replacement. J Interv Cardiol. 2020;2020:1807909. doi:10.1155/2020/1807909