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

Long-term survival after transcatheter aortic valve implantation (TAVI) remains difficult to estimate, and established risk scores perform suboptimally in this setting. We aimed to develop and externally validate a simple bedside score for prediction of long-term mortality after transfemoral TAVI.

In this multicentre study, 585 consecutive patients who underwent transfemoral TAVI with self-expanding valve systems comprised the derivation cohort, whereas 117 patients formed an independent external validation cohort. Predictors of 3-year all-cause mortality were identified using least absolute shrinkage and selection operator-Cox regression and multivariable Cox modelling. Model performance was assessed using discrimination, calibration, decision curve analysis, and net reclassification improvement.

Six routinely available variables-age > 80 years, male sex, estimated glomerular filtration rate < 60 mL/min, atrial fibrillation, anemia, and diabetes mellitus-were incorporated into the SALZBURG Score (0-11 points). In the derivation cohort, the score predicted 3-year mortality with an area under the curve of 0.66 (95% confidence interval, 0.61-0.71), which outperformed the European System for Cardiac Operative Risk Evaluation (EuroSCORE) II (0.56; P = 0.002), the Society of Thoracic Surgeons (STS) Score; 0.57; P = 0.005), and the Transcatheter Aortic Valve Replacement (TAVR)-Risk Score (0.62; P = 0.035), and showed discrimination similar to the TAVI₂-SCORe (0.63; P = 0.166). Calibration was good across predefined risk groups, and risk reclassification improved compared with established surgical and TAVI-specific risk models. In the external validation cohort, discrimination remained stable (C-index, 0.62; 95% confidence interval, 0.54-0.69).

The SALZBURG Score is a simple and externally validated bedside tool for estimating long-term mortality risk after transfemoral TAVI using routinely available clinical variables. Pending validation in larger contemporary TAVI cohorts, it might serve as a complementary tool to support individualized long-term risk assessment and multidisciplinary heart team discussions.