Prognostic value of aortic valve calcification score in combination with EuroSCORE Ⅱ for predicting outcome after transcatheter aortic valve replacement

YANG Fan; ZHENG Zheng; TAO Jing; YANG Yi-ning

doi:10.3969/j.issn.1672-5301.2025.02.006

Abstract：Objective To investigate the prognostic value of aortic valve calcium score(AVCS)combined with EuroSCORE Ⅱ in predicting major adverse cardiovascular and cerebrovascular events(MACCE)after transcatheter aortic valve replacement(TAVR)and to establish a predictive model for MACCE risk assessment.Methods 200 patients with severe aortic stenosis who underwent TAVR at the People's Hospital of Xinjiang Uygur Autonomous Region from January 2016 to December 2023 were included.The demographic,clinical,imaging and surgical data were collected.The electrocardiograms,echocardiograms,CT angiography(CTA)and procedural records were analyzed by the Specialists.A multivariate Cox regression model was constructed to identify the predictors of MACCE,and the predictive performance was evaluated using receiver operating characteristic(ROC)curve analysis.Result After a median follow-up of 21 months,49 patients(24.5％)experienced MACCE,including 20 cases of all-cause mortality(10％),3 non-fatal myocardial infarctions(1.5％),8 valve-related complications(thrombosis,paravalvular leak,or reintervention;4％),7 strokes(3.5％)and 11 unplanned cardiac-related hospitalizations(5.5％).The MACCE group had higher proportions of hypertension,diabetes,bicuspid valves,moderate-to-severe aortic valve calcification,high-risk EuroSCORE Ⅱscores,with older age and elevated creatinine levels compared to the non-MACCE group(P＜0.05).Kaplan-Meier analysis revealed a significantly reduced survival in patients with severe aortic calcification(log-rank P＜0.01)and high EuroSCORE Ⅱ scores(log-rank P＜0.01).Multivariate Cox regression identified ethnicity(HR=0.278,95％CI 0.130-0.595,P=0.001),hypertension(HR=2.052,95％CI 1.023-4.119,P=0.043),diabetes(HR=1.912,95％CI 1.037-3.526,P=0.038),EuroSCORE Ⅱ(HR=1.372,95％CI 1.080-1.742,P=0.010)and AVCS(HR=1.001,95％CI 1.000-1.002,P=0.016)as the independent risk factors for MACCE.The predictive model incorporating these factors achieved an area under the ROC curve of 0.72.Conclusion As emerging assessment tools,the aortic valve calcification score and EuroSCORE Ⅱ score have been shown to possess a certain degree of predictive value in relation to the prognosis of TAVR patients suffering from aortic stenosis.Furthermore,the efficacy of these two tools in combination with the independent risk factors mentioned above in predicting major adverse cardiovascular events(MACCE)has been demonstrated to be superior,thus indicating a certain degree of clinical efficacy.