Predictors of requirement for urgent versus elective TAVI and comparison of short and medium outcomes

Previous studies have shown mixed results comparing short-term mortality in patients undergoing urgent transcatheter aortic valve implantation (Urg-TAVI) compared with elective procedures (El-TAVI) for severe aortic stenosis (AS). This study aimed to explore the predictors of requirement for Urg-TAVI versus El-TAVI, as well as compare differences in short- and intermediate-term mortality. This single-centre, retrospective cohort study investigated 358 patients over three years. Baseline demographic data were collected for patients undergoing elective and urgent procedures, and mortality outcomes at one-month, one-year and three-year follow-up were compared. Urg-TAVI was required in 131 (36.6%) patients. Patients undergoing Urg-TAVI were significantly more likely to be female, have poor left ventricular (LV) function, with higher baseline creatinine and higher clinical frailty score (CFS). Higher rates of vascular complications were independently associated with increased mortality at one month. Mortality at one year was associated with higher creatinine level (odds ratio [OR] 1.01, 95% confidence interval [CI] 1.00 to 1.01, p=0.0013) and an urgent procedure (OR 2.25, 95%CI 1.28 to 3.97, p=0.0048). There remained a higher mortality in the urgent patients at three-year follow-up. In conclusion, undergoing TAVI urgently did not have a statistically significant effect on 30-day mortality. However, over long-term follow-up of one year, it was associated with worse mortality than elective TAVI, and this persisted out to three years.