PRIORiTize-TAVI might predict more than transcatheter aortic valve replacement waiting list priorities
Authors: Bistrovic P , Cikara T , Vidjak M , Bistrovic K , Busic N , Lisicic A , Novak A , Unic D , Sipic T , Pavlovic N , Manola S , Zeljkovic I , Hadzibegovic I , Jurin I 
Published: October 2024

Background

PRIORiTize-TAVI (Predicting moRtalIty Or uRgent TAVI on waiting list) is a novel scoring system targeting identification of patients at risk of urgent hospitalization or death whilst waiting for transcatheter aortic valve replacement (TAVR) (1). Patients are divided into those with low (&lt;2 points), intermediate (3-4 points) and high (&gt;5) waiting risk. Given the novelty of the score, additional research is required to further validate it. However, being compiled of parameters applied in everyday practice that are readily available, the application of the score might have the potential to go beyond its original purpose.

Purpose

We aimed to investigate whether PRIORiTize-TAVI score can predict postprocedural complications and survival following TAVR.

Methods

We conducted a registry-based study including patients who underwent TAVR at our institution from 2018 to 2023. PRIORiTize-TAVI was calculated summarizing points according to NYHA status, left ventricular ejection fraction (LVEF), NTproBNP, mean pressure gradient (meanPG) and Charlson comorbidity index (CCI) at the time of patient placement onto TAVR waiting list.

Results

This registry-based study included 252 patients with median age 80 (interquartile range (IQR) 76-84) years, 50% female. Median PRIORiTize score was 5 (IQR 3-7). There were 41 (16%) low, 51 (20%) intermediate and 160 (64%) high risk patients.

High risk patients had more frequently atrial fibrillation and ischaemic stroke, had lower LVEF and estimated glomerular filtration rate (eGFR), higher NTproBNP levels and CCI (Table 1). MeanPG also statistically differed between intermediate risk group and low risk group, but not with high risk group (Table 1). TAVR waiting time was significantly shorter in high-risk patients in comparison to intermediate risk patients. There was no statistical difference regarding baseline characteristics between the three groups (Table 1).

There was no statistical difference in post-TAVR complications between the three groups. Survival significantly differed depending on PRIORiTize risk stratification (P=.023), as shown in Figure 1. Median survival time for high risk patients was 49 months (IQR 42-49), whereas the median survival time for intermediate and low risk patients could not be reached. High risk patients had lower survival probability compared to both intermediate (HR 4.089; CI 1.91-8.73) and low risk (HR 2.078; CI 0.77-5.59) patients. Intermediate risk patients had a higher survival probability compared to low risk patients (HR 0.508; CI 1.67-1.54). Length of TAVR waiting time had no significant association with overall survival (P=.891).

Conclusions

Our data show that PRIORiTize-TAVI has a potential to be used as a prognostic tool to predict survival probability post-TAVR. Our results suggest that prolonged time on TAVR waiting list did not negatively impact patient postprocedural complications nor survival.Table 1Figure 1