Evaluation of EUROSCORE II to determine the prognosis of patients with moderate-to-severe aortic stenosis: a long-term retrospective study

Abstract

Background and Aims Aortic stenosis (AS) was a prevalent heart valve disease whose morbidity and mortality can be reduced by aortic valve replacement (AVR) . EUROSCORE II assesses the perioperative mortality of severe AS patients undergoing AVR. This study explored EUROSCORE II's prognostic value for long-term all-cause mortality of Chinese patients with moderate-to-severe AS and determined whether AVR affects this. Methods Allocated to four groups following the EUROSCORE II (cut-off value of 4% ) and whether performed AVR, 544 patients with moderate-to-severe AS were enrolled. Baseline data, Kaplan-Meier, Cox regression and subgroup analysis were used to analyse the relationship between EUROSCORE II and participants' all-cause mortality. Furthermore, ROC analysis determining the optimal cut-off value of EUROSCORE II was utilized. Results During a median follow-up of 41.4 months, 177 (21.5%) participants reached the endpoint, with higher risks (EUROSCORE II ≥4%) and no AVR exhibited significantly increased all-cause mortality rates compared to other groups (55.4% vs. 6.5%, 13.4%, and 32.7%; P<0.001). Kaplan-Meier curves confirmed these findings (log-rank test P<0.001). Cox regression analysis revealed a 6.891-fold higher risk (HR, 6.891; 95% CI, 3.083-15.401; P<0.001) in patients without AVR with higher EUROSCORE II. The adjusted model (P<0.01) and subgroup analyses (without AVR P=0.001; with AVR P=0.029) supported EUROSCORE II's prognostic value for all-cause mortality. The optimal EUROSCORE II cut-off for predicting all-cause mortality in patients without AVR was 2.23% (AUC 0.675). Conclusions EUROSCORE II (cut-off value 4%) and AVR independently impact the long-term prognosis of patients with moderate-to-severe AS.