Identifying clinical determinants of TAVI futility in a real-world cohort
T Carlos, B Resende, L Rocha, M Grine, G Batista, A Silva, T Santos, M Simoes, L Leite, M Costa, L GoncalvesAbstract
Introduction
As transcatheter aortic valve implantation (TAVI) expands across clinical practice, it is frequently offered to high-risk, medically fragile patients with severe aortic stenosis. Although TAVI yields substantial clinical benefits, it may be futile in individuals with a life expectancy under one year or an anticipated functional improvement below 25%. Existing prognostic tools aid in patient selection but often fail to fully capture the multidimensional clinical complexity that influences outcomes.
Purpose
Identify additional baseline clinical predictors of TAVI futility within a real-world cohort, beyond traditional nutritional and frailty assessments.
Methods
We conducted a single-centre retrospective study of 639 consecutive patients who underwent TAVI between March 2020 and September 2023. After excluding individuals without follow-up data or those who died during the index hospitalisation, 537 patients were included in the final analysis. Futility was defined as all-cause mortality at 1 year. Baseline characteristics were compared between groups, and predictors of 1-year mortality were identified using binary logistic regression. Survival differences among subgroups were assessed with Kaplan–Meier analysis.
Results
One-year mortality occurred in 42 patients (7.8%). Compared with those who survived, patients in the futility group exhibited higher prevalences of stage IV–V chronic kidney disease (21.4% vs 10.5%; p=0.042) and prior pacemaker implantation (26.2% vs 11.7%; p=0.007). NT-proBNP levels were also elevated (3149 vs 1765 pg/mL; p=0.002), though this association did not remain significant after adjustment. Left ventricle ejection fraction (LVEF) showed limited ability to discriminate mortality on ROC analysis (AUC 0.418, Youden index 21%, p=0.09). However, in multivariable models, lower LVEF emerged as an independent predictor of futility (OR 0.97 per %, 95% CI 0.94–1.00; p=0.045), along with stage IV–V chronic kidney disease (OR 2.77, 95% CI 1.17–6.59; p=0.021) and prior pacemaker implantation (OR 3.64, 95% CI 1.54–8.61; p=0.003). Kaplan–Meier curves demonstrated consistently poorer survival in each of these high-risk groups.
Conclusion
Advanced chronic kidney disease, prior pacemaker implantation, and reduced LVEF were the strongest baseline predictors of 1-year mortality after TAVI. Incorporating these routinely available clinical factors into pre-procedural assessment may improve identification of patients at high risk for futility.For image description, please refer to the figure legend and surrounding text.For image description, please refer to the figure legend and surrounding text.