The STRAT Clinical Risk Score to Predict Early Ischemic Stroke Post-TAVI: findings from the FRANCE-TAVI registry

Background: Practitioners recommending transcatheter aortic valve implantation (TAVI) currently lack reliable tools to predict periprocedural ischemic stroke risk. We aimed to develop and internally validate a clinical risk score to accurately stratify this risk. Methods: Using data from the nationwide, multicenter FRANCE-TAVI registry, we developed a clinical predictive risk score for 30-day ischemic stroke post-TAVI using multivariable logistic regression analysis. The model was internally validated through cross-validation techniques. Results: Among 62,747 patients, 1,712 (2.7%), experienced ischemic stroke within 30 days. Nine clinical predictors were identified, namely female sex, age >85 years, weight 1) episodes of acute heart failure, severe mobility reduction, diabetes, and creatinine clearance <60 mL/min. The resulting scoring model demonstrated good accuracy (Brier score, 0.17), moderate discrimination (C-index, 0.63), and excellent calibration as assessed by calibration plots, calibration-in-the-large, and calibration slope. The score categorized patients into low (90.2% of the population), intermediate (8.0%) and high-risk (1.8%) groups. Observed stroke rates increased progressively across these groups, from 2.25% in the low-risk group to 6.51% in the intermediate-risk group and 10.10% in the high-risk group. Conclusions: This newly developed STRAT score is a clinical, practical, and effective tool for predicting early ischemic stroke in patients undergoing TAVI. It may help tailor preventive strategies. Further studies are necessary to externally validate this score and evaluate its impact on clinical decision-making.