Anar MAMMADDLI, Ayşe İrem DEMİRTOLA, Duygu İNAN, İhsan DEMİRTAŞ, Berk ERDİNÇ, Onur YILDIRIM, Alev KILIÇGEDİK
Anatolian Current Medical Journal - 2026;8(4):668-674
Aims: Despite advances in valve intervention strategies, mortality in patients with severe aortic stenosis remains considerable. The present study investigated whether age-appropriate SCORE2 risk classification provides prognostic information in patients with severe AS undergoing either transcatheter or surgical aortic valve replacement. Methods: This retrospective single-center study included 168 consecutive patients with severe AS who underwent surgical aortic valve replacement (SAVR) or transcatheter aortic valve implantation (TAVI). Cardiovascular risk was estimated using age-appropriate SCORE2 algorithms (SCORE2 for patients aged <70 years and SCORE2-OP for those >=70 years). Patients were classified into non-very high-risk and very high-risk groups. The primary endpoint was all-cause mortality during follow-up. Survival analyses were performed using Kaplan-Meier methods and Cox proportional hazards regression. Results: Among 168 patients (median age 73 [63-80] years; 51% male), 116 (69%) were classified as very high risk. During a median follow-up of 10 (4-16) months, 28 patients (17%) died. Mortality was higher in the very high-risk group (21% vs. 8%; p =0.02), with lower cumulative survival (log-rank p=0.03). In Cox analysis, very high SCORE2 risk predicted mortality (HR 3.22, 95% CI 1.11-9.30; p=0.031) and remained significant after adjustment (HR 3.40, 95% CI 1.11-10.41; p=0.032). Model discrimination improved after adjustment (AUC 0.60 to 0.70). Conclusion: Very high SCORE2 risk remained significantly associated with mid-term mortality in patients with severe AS undergoing TAVI or SAVR, suggesting that global cardiovascular risk assessment may provide complementary prognostic information after valve intervention.
