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Original research article
Does the CHA2DS2-Vasc score predict procedural and short-term outcomes in patients undergoing transcatheter aortic valve implantation?
  1. Tahir Hamid1,2,
  2. Tawfiq R Choudhury1,
  3. Simon G Anderson1,3,
  4. Izhar Hashmi4,
  5. Saqib Chowdhary2,
  6. David Hesketh Roberts4,
  7. Douglas G Fraser1,
  8. Ragheb Hasan1,
  9. Vaikom S Mahadevan1 and
  10. Richard Levy2
  1. 1Manchester Royal Infirmary, Central Manchester University NHS Foundation Trust, Manchester, UK
  2. 2University Hospital of South Manchester NHS Foundation Trust, Wythenshawe, UK
  3. 3Institute of Cardiovascular Sciences, University of Manchester, Manchester, UK
  4. 4Blackpool Teaching Hospitals NHS Foundation Trust, Blackpool, UK
  1. Correspondence to Dr Simon G Anderson; simon.anderson{at}manchester.ac.uk

Abstract

Background Transcatheter aortic valve implantation (TAVI) is associated with periprocedural and postprocedural morbidity and mortality. Currently, there is a paucity of risk stratification models for potential TAVI candidates. We employed the CHA2DS2-Vasc score to quantify the risk of 30-day mortality and morbidity in patients undergoing TAVI.

Methods and results A retrospective analysis of registry data for consecutive patients undergoing TAVI at 3 tertiary centres in Northwest England between 2008 and 2013. The CHA2DS2-Vasc score and its modification—the R2CHA2DS2-Vasc score, which includes pre-existing renal impairment and pre-existing conduction abnormality (right bundle branch block/left bundle branch block, RBBB/LBBB)—were calculated for all patients. A total of 313 patients with a mean age of 80 (79.1–80.8) years underwent TAVI. The implanted devices were either the CoreValve or the Edwards-SAPIEN prosthesis. The 30-day mortality was 14.3% in those with a CHA2DS2-Vasc score ≥6, whereas it was only 6.2% in those with a score <6 (p=0.04). Using the R2-CHA2DS2-Vasc score, the difference was more pronounced with a 30-day mortality of 22.6% in those patients with an R2-CHA2DS2-Vasc score ≥7 compared to 6.0% in those with a R2-CHA2DS2-Vasc score <7 (p=0.001). In multivariable Cox regression analyses, there was a significant and independent relationship between the CHA2DS2-Vasc score (hazard ratio (HR)= 2.71, (1.01 to 7.31); p<0.05) and the modified R2CHA2DS2-Vasc score (HR=4.27 (1.51 to 12.07); p=0.006) with 30-day mortality.

Conclusions Our study demonstrates the potential use of the CHA2DS2-Vasc or the R2CHA2DS2-Vasc score to quantify the risk of mortality in patients undergoing TAVI. This could have significant implications in terms of clinical as well as patients’ decision-making.

This is an Open Access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY 4.0) license, which permits others to distribute, remix, adapt and build upon this work, for commercial use, provided the original work is properly cited. See: http://creativecommons.org/licenses/by/4.0/

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