Clinical clustering TAVI patients: multivariate analysis of risk factors, clinical presentation, profiling and outcome association using a two-step cluster analysis

Introduction Despite advances in transcatheter aortic valve implantation (TAVI), patient outcomes remain variable due to the complex interplay of multiple risk factors. Although these factors are well-established predictors, the combined effect of their interactions on clinical outcomes remains challenging to predict. This study aims to stratify TAVI patients according to clinical and risk factor variables, identify distinct risk profile clusters, and examine their association with outcomes. Methods A retrospective analysis of 300 patients who underwent successful TAVI was conducted. A two-step cluster analysis was performed to group patients based on clinical presentation and risk factors. Two clusters were identified: Cluster 1 and Cluster 2. The primary endpoint included death at 30 days, stroke, and hospital readmission within one year. Baseline characteristics, procedural variables, and outcomes were compared between clusters. Results Among 300 TAVI patients, Cluster 1 (n=182) and Cluster 2 (n=32) exhibited similar age and gender distribution, with a mean age of 82±5 and 83±5 years (p=0.6) and females in 54% and 50% (p=0.7), respectively. Comorbidities such as diabetes, chronic kidney disease, and atrial fibrillation were comparable between groups (table 1). Yet, Cluster 1 had a higher prevalence of severe symptoms (NYHA class > 2 in 52% vs. 25%, p=0,005), previous hospitalization for aortic stenosis (28% vs. 3%, p=0.03), and significant mitral regurgitation (30% vs. 12%, p=0,05). Cluster 1 also exhibited a shorter waiting period (48 [24-72] vs. 93 [47-139], p=0,03), potentially reflecting prioritization based on disease presentation severity. Cluster 1 was associated with significantly better outcomes despite a higher symptomatic burden. Outcome analysis revealed that Cluster 2 was associated with worse outcomes, including higher 30-day and 1-year mortalities (12% vs. 2%, p<0.001 and 29% vs. 7%, p<0.001) and stroke (6% vs. 0.5%, p<0.01). Hospital readmission rates were also significantly higher in Cluster 2 (16% vs 0.5%, p<0.001). Symptomatic burden with hospitalization may result in an earlier TAVI, as a shorter waiting time is associated with better outcomes. Conclusion Multivariate clustering of clinical presentation and risk factors successfully identified two distinct clusters of profiles with divergent TAVI outcomes. Notably, despite having more symptomatic disease (as indicated by a higher NYHA class) and a history of hospitalization, patients were associated with better outcomes. The shorter waiting period highlights the potential benefit of earlier intervention for more symptomatic patients. In contrast, Cluster 2 patients experienced higher mortality, stroke, and hospital readmission rates, possibly reflecting the detrimental impact of delays. Earlier prioritization of symptomatic patients for TAVI could significantly improve clinical outcomes.Baseline characteristics Outcomes