The SALZBURG score: a comorbidity-focused model for long-term survival stratification following TAVI

Background Reliable estimation of long-term survival after transcatheter aortic valve implantation (TAVI) remains challenging, and commonly used surgical scores, including the EuroScore II, show limited prognostic accuracy in this setting. We aimed to identify simple clinical predictors of 3-year mortality and to develop an intuitive, bedside-applicable risk score. Methods In this single-center cohort study, 585 consecutive TAVI patients (follow-up of at least 3.8 years) were analyzed. LASSO-Cox regression was used to select predictors of 3-year all-cause mortality, followed by multivariable Cox modeling. A point-based score was constructed by scaling regression coefficients, and its discriminative performance was assessed using Kaplan–Meier analyses and receiver operating characteristic (ROC) curves. The EuroScore II served as comparator. Results Six routinely available clinical variables—age > 80 years, male sex, eGFR < 60 ml/min, atrial fibrillation, anemia, and diabetes mellitus—were identified as independent predictors and incorporated into the SALZBURG score (range 0–11 points). Increasing score levels showed a stepwise rise in 3-year mortality, with clear separation of low-, intermediate-, and high-risk groups (log-rank p < 0.001). The SALZBURG score demonstrated good discriminative performance (AUC 0.662; 95% CI 0.611–0.714), significantly (p = 0.002) outperforming the EuroScore II (AUC 0.564;95% CI 0.508–0.620). The score requires no imaging parameters or specialized assessments and can be calculated within seconds using standard pre-TAVI data. Conclusion The SALZBURG score provides simple, robust, and clinically meaningful prediction of 3-year mortality after TAVI and outperforms the EuroScore II while relying on fewer and more readily available variables. Its ease of use supports integration into routine evaluation, and external validation is warranted to confirm its generalizability.