Incidence and predictors of deaht and heart failure hospitalization on TAVI waiting list: a multicenter italian registry

Background Transcatheter aortic valve implantation (TAVI) is the standard treatment for severe aortic stenosis (AS). However, prolonged waiting times expose patients to substantial pre-procedural risk. Identifying predictors of adverse events during the waiting period may support risk-based prioritization. Purpose To assess incidence and predictors of death or heart failure (HF) hospitalization while awaiting TAVI. Methods In this multicenter registry across six Italian centers, consecutive patients listed for TAVI between March 2016 and November 2024 were included. The primary endpoint was a composite of all-cause death or HF hospitalization during the waiting period. Predictors were assessed using Cox proportional hazards models. Results Among 1074 patients (mean age 82±5 years; 49% women), median waiting time was 133 days. During waiting, 230 patients (21.4%) reached the primary endpoint, including 49 deaths (4.6%) and 144 HF hospitalizations (13.4%). Notably, a significant clustering of mortality occurred within the first 90 days. Independent predictors of adverse events included chronic kidney disease (HR 1.78; 95%CI 1.24–2.55; p=0.002), LVEF <50% (HR 1.67; p=0.004), NYHA class III (HR 1.70; p=0.020), anemia (HR 1.46; p=0.025), and high-risk clinical presentation (HR 1.50; p=0.018). Conclusions One in five patients awaiting TAVI experiences death or HF hospitalization, with a critical early vulnerability window. Risk-stratified prioritization based on renal function, systolic dysfunction, and symptom severity may reduce avoidable pre-procedural morbidity and mortality.