Evidence map›Paper›PMID 40549031›Full record

ArticleClinical research in cardiology : official journal of the German Cardiac Society2025

Fighting time: the critical importance of pre-TAVR mortality risk prediction.

Jasmin Shamekhi, Marius Ebert, Angelina Lorek, Irina Eckardt, Baravan Al-Kassou, Mustafa Mousa Basha, Marcel Weber, Miriam Silaschi, Farhad Bakhtiary, Georg Nickenig and 1 more

Abstract read
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In one paragraph

Article in Clinical research in cardiology : official journal of the German Cardiac Society, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
2citing papers in PubMed, 1 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

2 citing papers in PubMed, 1 synthesis or guideline pooled it.

  1. Pooled it
  2. Prognostic impact of iliofemoral access-site calcification volume on outcomes after transcatheter aortic valve implantation.Clinical research in cardiology : official journal of the German Cardiac Society · 2026
    Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

11 authors.

Jasmin ShamekhiHeart Center Bonn, Department of Medicine II, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany. jasmin.shamekhi@ukbonn.de.ORCID http://orcid.org/0000-0002-5724-9814
Marius EbertHeart Center Bonn, Department of Medicine II, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany.
Angelina LorekHeart Center Bonn, Department of Medicine II, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany.
Irina EckardtHeart Center Bonn, Department of Medicine II, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany.
Baravan Al-KassouHeart Center Bonn, Department of Medicine II, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany.
Mustafa Mousa BashaHeart Center Bonn, Department of Medicine II, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany.
Marcel WeberHeart Center Bonn, Department of Medicine II, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany.
Miriam SilaschiHeart Center Bonn, Cardiac Surgery, University Hospital Bonn, Bonn, Germany.
Farhad BakhtiaryHeart Center Bonn, Cardiac Surgery, University Hospital Bonn, Bonn, Germany.
Georg NickenigHeart Center Bonn, Department of Medicine II, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany.
Sebastian ZimmerHeart Center Bonn, Department of Medicine II, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundSymptomatic severe aortic valve stenosis (AS) is a life-threatening condition requiring prompt medical attention. While transcatheter aortic valve replacement (TAVR) is an effective treatment, current scheduling practices often do not account for individual patient risk profiles due to limited data on mortality rates during the waiting period and a lack of viable risk assessment. Consequently, non-prioritized wait times may be unacceptably long for high-risk patient populations.

objectiveThis study aimed to evaluate the mortality rate of patients with symptomatic severe AS awaiting TAVR and identify pragmatic clinical risk predictors during this period.

methodsBetween January 2019 and December 2023, 2,454 patients with symptomatic severe AS, were scheduled for TAVR after an interdisciplinary Heart Team discussion at the Heart Center Bonn. Mortality during the waiting period was assessed, and the characteristics of survivors (patients who underwent TAVR) were compared to non-survivors (patients who died before the procedure).

resultsThe median waiting time for TAVR was 41 days. A total of 105 (4.3%) patients died during the waiting period, with a median time to death of 29 days. By comparison, 30 day post-TAVR mortality, including the intervention, was 1.7%. Multivariate regression analysis identified independent predictors of pre-TAVR mortality including reduced left ventricular ejection fraction, decreased estimated glomerular filtration rate, mitral regurgitation, tricuspid regurgitation, and advanced heart failure symptoms. An IMPACT score, incorporating these parameters, strongly predicted outcome with a hazard ratio for mortality of 2.1 greatly outperforming both EuroSCORE II and STS-PROM. The IMPACT score of ≥ 5 identified high-risk patients with a pre-TAVR mortality rate of 12.6%.

conclusionThe mortality rate for patients with symptomatic severe AS awaiting TAVR is unacceptably high. Utilizing the IMPACT score could enable precise risk stratification, identifying patients who require urgent or prioritized intervention to improve outcomes.

Indexed as

Aortic Valve StenosisTime-to-TreatmentTranscatheter Aortic Valve ReplacementWaiting ListsAgedAged, 80 and overFemaleGermanyHumansMaleRetrospective StudiesRisk AssessmentRisk FactorsSeverity of Illness IndexSurvival RateTime FactorsAortic valve stenosisIMPACT scoreMortality rateRisk stratificationTAVRTranscatheter aortic valve replacementWaiting time for TAVR

Identifiers

PMID40549031
PMCPMC12540598

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LicenceCC BY
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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.