The SALZBURG Score: A Simple Clinical Tool for Long-Term Risk Stratification After Self-Expanding Transcatheter Aortic Valve Implantation

BACKGROUND: 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. METHODS: In this multi-center study, 585 consecutive patients undergoing transfemoral TAVI with self-expanding valve systems comprised the derivation cohort, while 117 patients formed an independent external validation cohort. Predictors of 3-year all-cause mortality were identified using LASSO-Cox regression and multivariable Cox modeling. Model performance was assessed by discrimination, calibration, decision curve analysis, and net reclassification improvement. RESULTS: Six routinely available variables-age >80 years, male sex, eGFR <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 AUC of 0.66 (95% CI 0.61-0.71), outperforming EuroSCORE II (0.56; p=0.002), the STS Score (0.57; p=0.005), and the TAVR-Risk Score (0.62; p=0.035), while showing similar discrimination compared with 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% CI 0.54-0.69). CONCLUSIONS: 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 may serve as a complementary tool to support individualized long-term risk assessment and multidisciplinary Heart Team discussions.