Head-to-head comparison of complete blood count-derived inflammatory indices for predicting 1-year mortality after transcatheter aortic valve implantation

Several complete blood count-derived inflammatory indices have been proposed for risk stratification after transcatheter aortic valve implantation (TAVI), but their relative prognostic value remains uncertain. We compared preprocedural and early postprocedural indices to identify the most informative marker for 1-year outcomes. This retrospective single-center study included 413 patients undergoing transfemoral TAVI in 2023. Preprocedural indices were available for all patients and postprocedural indices within 24 h for 407. The primary endpoint was 1-year all-cause mortality; the secondary endpoint was all-cause readmission within 1 year after discharge from the index TAVI hospitalization. Mortality discrimination was assessed by receiver operating characteristic analysis, and independent associations were evaluated using multivariable logistic regression. Model performance was further assessed using calibration, internal bootstrap validation, and decision curve analysis. During 1-year follow-up, 85 patients (20.6%) died. Among 407 patients with complete early postprocedural blood counts, postprocedural neutrophil-to-lymphocyte ratio (NLR) showed the highest discrimination for mortality (AUC 0.746, 95% CI 0.678–0.808). In the fully adjusted model, postprocedural NLR remained independently associated with mortality (adjusted OR 2.65, 95% CI 1.96–3.60; P < 0.001), whereas no composite index showed a higher AUC. The final model achieved an AUC of 0.787. Hospitalization discrimination was modest. Early postprocedural NLR showed the highest discriminatory performance for 1-year mortality among routinely available hematologic inflammatory indices after TAVI. Its simplicity and availability suggest potential utility as an adjunctive marker for early postprocedural risk stratification. Not applicable. Not applicable.