Prognostic value of the endothelial activation and stress index (EASIX) for in-hospital and overall mortality in patients undergoing transcatheter aortic valve implantation

Patients undergoing transcatheter aortic valve implantation (TAVI) are typically elderly with multiple comorbidities, making accurate preprocedural risk stratification essential. The Endothelial Activation and Stress Index (EASIX), calculated from lactate dehydrogenase, creatinine, and platelet count, reflects endothelial injury and systemic stress, however, its incremental prognostic value beyond established risk markers in TAVI populations has not been fully characterized.This study aimed to evaluate the association between preprocedural EASIX and both in-hospital and overall mortality after TAVI. This retrospective cohort study included 742 consecutive patients who underwent TAVI for symptomatic severe aortic stenosis between January 2020 and January 2025. EASIX was calculated from laboratory parameters obtained 48–72 h before the procedure, and patients were stratified into tertiles. The primary outcome was overall mortality; in-hospital mortality was the secondary outcome. Cox proportional hazards and logistic regression analyses identified independent predictors. Incremental prognostic value was evaluated using Harrell’s C-index, continuous Net Reclassification Improvement (NRI), and Integrated Discrimination Improvement (IDI), and survival was assessed by Kaplan–Meier analysis. The median age was 78 years (IQR 74–83), and 56.2% were female. During a median follow-up of 345 days, overall mortality occurred in 119 patients (16.0%) and in-hospital mortality in 63 (8.5%). Patients in the highest EASIX tertile had higher in-hospital (15.4%) and overall mortality (25.9%) than lower tertiles (p < 0.001). One-year survival was 87.4%, 93.4%, and 78.1% across tertiles 1–3, respectively (log-rank p < 0.001). EASIX independently predicted overall mortality (HR 1.21 per unit, 95% CI 1.07–1.38; p = 0.003) and in-hospital mortality (OR 1.29, 95% CI 1.05–1.59; p = 0.016). Adding EASIX to a base model (age, sex, LVEF, lnBNP) significantly improved reclassification for both endpoints (NRI = 0.314 and 0.357; IDI = 0.022 and 0.019; all p < 0.05). Preprocedural EASIX is independently associated with both in-hospital and overall mortality after TAVI and provides incremental reclassification beyond established clinical and biomarker variables. As an easily obtainable index from routine laboratory parameters, EASIX may serve as a simple and practical tool for preprocedural risk stratification, complementing rather than replacing established biomarkers such as BNP. Prospective multicenter studies are needed to validate these findings.