A geriatric assessment score predicted 1-year mortality or functional decline after TAVI with AUC 0.92, outperforming STS score (AUC 0.60) in older adults.
Does a novel geriatric assessment-based risk score improve prediction of 1-year mortality or functional decline compared to conventional surgical models in older TAVI candidates?
A novel geriatric assessment-based risk score significantly outperforms the conventional STS score in predicting 1-year mortality or functional decline in older adults undergoing TAVI.
Absolute Event Rate: 0% vs 0%
Abstract Background Many older adults undergoing transcatheter aortic valve implantation (TAVI) do not derive meaningful benefit at 1 year, highlighting the need for improved risk stratification beyond conventional surgical scores. Current models, such as the Society of Thoracic Surgeons (STS) score, may not fully capture older patients' vulnerability, highlighting the need for a geriatric assessment-based risk score. Methods This prospective multicenter study (2020–2022) enrolled consecutive patients aged ≥75 years with severe symptomatic aortic stenosis evaluated for TAVI at three high-volume centers. Patients were split into derivation (66%) and validation (34%) cohorts. A comprehensive geriatric assessment included basic activities of daily living (BADL), Mini Nutritional Assessment–Short Form (MNA-SF), renal function (eGFR), cognitive screening, and echocardiographic parameters. The primary outcome was a composite of all-cause mortality or new/worsened functional disability (≥2 BADL lost or failure to improve) at 1 year. Logistic regression identified predictive factors, and a novel risk score was developed and validated. Results Among 562 patients (median age, 83 years; 58.5% women), 52 died (9.3%) and 26 experienced functional decline, resulting in a composite outcome of 13.9%. Malnutrition risk, BADL impairment, lower eGFR, and higher pulmonary artery systolic pressure independently predicted negative outcomes. The derived risk score demonstrated superior discrimination (AUC 0.92, 95% CI 0.88-0.96) versus the STS score (AUC 0.60) and the Multidimensional Prognostic Index (AUC 0.73) (P.001). Validation confirmed strong predictive performance (AUC 0.87 vs. STS 0.44, P.001) with a high negative predictive value (Figure). Conclusions A novel geriatric assessment-based risk score outperformed conventional surgical models in predicting 1-year mortality or functional decline in older TAVI candidates. Integrating key domains of nutrition, functional status, renal function, and echocardiographic measures may refine patient selection and resource allocation.
Fumagalli et al. (Sat,) reported a other. A geriatric assessment score predicted 1-year mortality or functional decline after TAVI with AUC 0.92, outperforming STS score (AUC 0.60) in older adults.