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Preprocedural CALLY Index As a Novel Predictor of Pacemaker Requirement After Transcatheter Aortic Valve Replacement
Haitham Abu Khadija1, Nizar Abu Hamdeh2, Mohammad Masu'd2
1Heart Centre, Kaplan Medical Centre, Rehovot, Israel, affiliated with the Hebrew University, Jerusalem, Israel.
Insights
The C-reactive protein-albumin-lymphocyte (CALLY) index may predict pacemaker needs after transcatheter aortic valve replacement (TAVR). A higher CALLY index is linked to a lower risk of permanent pacemaker implantation (PPI) within 30 days.
Area of Science:
- Cardiology
- Biomarkers
- Medical Informatics
Background:
- Permanent pacemaker implantation (PPI) is a frequent complication following transcatheter aortic valve replacement (TAVR).
- Predictive patient-related markers for PPI post-TAVR are not well-established.
- The C-reactive protein-albumin-lymphocyte (CALLY) index is a potential novel marker.
Purpose of the Study:
- To evaluate the CALLY index's ability to predict 30-day PPI after TAVR.
- To assess the CALLY index's utility in risk stratification for TAVR patients.
- To determine if the CALLY index offers independent predictive value for PPI.
Main Methods:
- Retrospective analysis of 812 TAVR patients with baseline laboratory data.
- Calculation of the CALLY index: (albumin × lymphocytes ÷ C-reactive protein) ×10.
- Kaplan-Meier curves and multivariable Cox regression to assess the association between CALLY index quartiles and PPI risk.
Main Results:
- 17.9% of patients required PPI within 30 days.
- Higher CALLY index quartiles demonstrated a progressively lower risk of PPI.
- The highest quartile (Q4) showed a significant independent protective association with 30-day PPI (HR 0.57, 95% CI 0.35-0.94).
Conclusions:
- A higher preprocedural CALLY index is independently associated with a reduced likelihood of requiring a pacemaker after TAVR.
- The CALLY index serves as a simple, cost-effective tool for enhancing pre-TAVR risk assessment.
- Utilizing the CALLY index may aid in optimizing periprocedural planning for TAVR.
Background:
Permanent pacemaker implantation (PPI) is a common complication after transcatheter aortic valve replacement (TAVR). Although procedural and electro-anatomic factors are well established, patient-related susceptibility markers remain unclear. We aimed to evaluate whether the preprocedural C-reactive protein-albumin-lymphocyte (CALLY) index independently predicts and aids in risk stratification for 30-day PPI after TAVR.
Methods:
We retrospectively analyzed 812 consecutive TAVR patients with complete baseline labs (2010-2025). The CALLY index was calculated as (albumin × lymphocytes ÷ C-reactive protein) ×10, and patients were stratified into quartiles (Q1-Q4). The primary endpoint was new PPI within 30 days. Kaplan-Meier curves and Cox regression assessed the association between CALLY index quartiles and PPI risk. Multivariable models adjusted for prespecified clinical, anatomic, and procedural factors. Subgroup analyses evaluated consistency across age, sex, hypertension, and valve type.
Results:
Median time to PPI was 4 days (interquartile range 2-9), and 145 patients (17.9%) required implantation. Higher CALLY index quartiles were associated with a progressively lower PPI risk compared with Q1: Q2 hazard ratio (HR) 0.64 (95% confidence interval [CI] 0.42-0.99), Q3 HR 0.63 (95% CI 0.41-0.98), and Q4 HR 0.50 (95% CI 0.31-0.79). After multivariable adjustment, Q4 remained independently protective (HR 0.57, 95% CI 0.35-0.94). The protective effect of Q4 was consistent across subgroups, including age ≥ 80 years, male patients, female patients, hypertensive patients, and recipients of self-expanding valves. No significant effect modification was observed.
Conclusions:
A higher preprocedural CALLY index was independently linked to a lower 30-day pacemaker requirement after TAVR. As a simple, inexpensive marker, the CALLY index may improve pre-TAVR risk stratification and guide periprocedural planning.
