OLD-TAVR score to predict 2-year mortality in patients aged 75 years and more undergoing transcatheter aortic valve replacement

PurposeDecision-making on transcatheter aortic valve replacement (TAVR) in patients aged 75 years and older is complex. It could be facilitated by the identification of predictors of long-term mortality. This study aimed to identify predictors of 2-year mortality to develop a 2-year mortality risk score.MethodsCohort study of consecutive patients aged >= 75 years who underwent TAVR after a comprehensive geriatric assessment (CGA) at our university hospital between 2012 and 2019. Predictors of 2-year mortality were determined using multivariable Cox regression. A point-based predictive model was developed based on risk factors and subsequently internally validated by fivefold cross-validation.ResultsThe 345 patients (median age 87 years, 54% women) were fit/vulnerable (32%), mildly frail (37%), or moderately/severely frail (31%). The overall 2-year mortality rate was 26%, predicted by atrial fibrillation, hemoglobin <= 10 g/dL, age >= 87 years, BMI <= 24, eGFR <= 50 ml/min, and moderate/severe frailty. The risk score (range 0-12), named OLD-TAVR score, for 2-year mortality showed good discriminative power (AUC 0.70) and remained consistent after fivefold cross-validation (cvAUC 0.69). A risk score >= 8 (prevalence 20%) predicted a 45% (95%CI: 34-58%) two-year mortality, with high specificity (86%) and good positive predictive power (+ LR 2.43).ConclusionA 2-year mortality risk score (OLD-TAVR score) for very old patients undergoing TAVR was developed based on six bio-clinical items. A score >= 8 identified patients in whom 2-year mortality was very high and thereby the TAVR futile. Key summary pointsAimThis study aimed to identify predictors of 2-year mortality in very old (aged 75+) after transcatheter aortic valve replacement (TAVR), with special attention to frailty, to develop a 2-year mortality risk score.FindingsFrailty is prevalent in older patients with severe aortic stenosis (68%) and enhanced discriminative power of a newly developed 12-point score (OLD-TAVR) to estimate 2-year mortality after TAVR.MessageDuring a pre-TAVR assessment of older patients, the use of specific risk scores of long-term mortality, encompassing a frailty measure such as the Clinical Frailty Scale, may improve the identification of older patients in which TAVR might be futile.