The SALZBURG Score: A Simple Clinical Tool for Long-term Risk Stratification After Self-Expanding Transcatheter...

Area of Science:

• Cardiovascular Medicine
• Interventional Cardiology
• Health Outcomes Research

Background:

• Estimating long-term survival after transcatheter aortic valve implantation (TAVI) is challenging.
• Existing risk scores demonstrate suboptimal performance in TAVI patients.
• Accurate risk prediction is crucial for guiding treatment decisions and patient management.

Purpose of the Study:

• To develop and externally validate a simple bedside score for predicting long-term mortality after transfemoral TAVI.
• To identify routinely available clinical variables associated with long-term mortality post-TAVI.
• To compare the performance of the new score against established risk prediction models.

Main Methods:

• A multicentre study involving 585 patients for derivation and 117 for external validation.
• Least absolute shrinkage and selection operator-Cox regression and multivariable Cox modelling were used to identify predictors.
• Model performance was evaluated using discrimination, calibration, and reclassification metrics.

Main Results:

• The SALZBURG Score, incorporating age, sex, kidney function, atrial fibrillation, anemia, and diabetes, demonstrated good predictive performance (AUC 0.66).
• The SALZBURG Score outperformed EuroSCORE II, STS Score, and TAVR-Risk Score in predicting 3-year mortality.
• External validation confirmed stable discrimination (C-index 0.62), with improved risk reclassification compared to existing models.

Conclusions:

• The SALZBURG Score is a simple, externally validated bedside tool for estimating long-term mortality risk after transfemoral TAVI.
• It utilizes routinely available clinical variables, facilitating its use in clinical practice.
• The score can complement existing tools for individualized risk assessment and support multidisciplinary heart team discussions.