ArticleClinical research in cardiology : official journal of the German Cardiac Society2025
Patient risk evaluation for transcatheter aortic valve replacement (PRE-TAVR) - identification of real-time predictors of short- and long-term mortality.
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 1 paper.
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1 citing paper in PubMed.
- Clinical Utility and Limitations of Traditional Risk Scores (EuroSCORE, EuroSCORE II, and STS-PROM) in Patients Undergoing TAVI: A Narrative Review.Journal of clinical medicine · 2026Review
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9 authors.
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Abstract
backgroundThe steadily increasing number of transcatheter aortic valve replacement (TAVR) procedures being performed on a heterogeneous patient population highlights the need for robust risk assessment. While EuroSCORE II is well established for surgical risks, it is less effective for TAVR, and the newer STS/ACC TAVR score has so far been validated mainly for in-hospital and 30-day mortality.
aimsThis study aims to improve risk stratification for TAVR patients by identifying real-time predictors of 30-day and 1-year mortality that incorporate comprehensive, procedure-specific factors.
methodsFive-year data from 2256 transfemoral TAVR procedures performed at two German Heart Centers (2017-2022) were retrospectively analyzed. Predictors of 1-year and 30-day mortality were assessed using multivariable logistic and LASSO regression, considering a broad spectrum of patient demographics, comorbidities, and peri-procedural factors.
resultsThe analyses revealed a predictor model (PRE-TAVR predictors) for 1-year mortality (AUC 0.770; 95% CI 0.731-0.809), including age (> 81.5 years), NYHA stage IV, COPD (GOLD ≥ 2), atrial fibrillation, previous stroke or malignancy, elevated C-reactive protein (≥ 9.5 mg/L), aortic valve ΔP mean ≥ 48.5 mmHg, peripheral arterial disease (> stage 2) and low platelet count (≤ 228.5 g/L). The accuracy of the model exceeded the EuroSCORE II (AUC 0.645; 95% CI 0.599-0.691) and the STS/ACC TAVR score (AUC 0.714; 95% CI 0.670-0.758). For 30-day mortality, NYHA class IV was the only significant predictor in the bivariate analyses. However, additional LASSO analyses identified pre-existing renal insufficiency (KDIGO stage ≥ 3) and pre-TAVR sodium levels as further significant predictors. The AUC was 0.699 (95% CI 0.611-0.788) compared to an AUC of 0.680 (95% CI 0.604-0.756) for EuroSCORE II and 0.7129 (95% CI 0.633-0.793) for the STS/ACC TAVR score.
conclusionThe PRE-TAVR study developed a robust model, particularly for predicting 1-year mortality. This model outperformed the EuroSCORE II and STS/ACC TAVR scores, despite requiring fewer variables. It provides a solid basis for future risk scores and enables more precise patient selection.
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