title: Does the CHA2DS2-Vasc score predict procedural and short-term outcomes in patients undergoing transcatheter aortic valve implantation?
abstract: 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.
  
  
  
  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.
  
  
  
  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.
authors.affiliation: Manchester Royal Infirmary, Central Manchester University NHS Foundation Trust , Manchester , UK ; University Hospital of South Manchester NHS Foundation Trust , Wythenshawe , UK.
authors.forename: Tahir
authors.initials: T
authors.lastname: Hamid
authors.affiliation: Manchester Royal Infirmary, Central Manchester University NHS Foundation Trust , Manchester , UK.
authors.forename: Tawfiq R
authors.initials: TR
authors.lastname: Choudhury
authors.affiliation: Manchester Royal Infirmary, Central Manchester University NHS Foundation Trust , Manchester , UK ; Institute of Cardiovascular Sciences, University of Manchester , Manchester , UK.
authors.forename: Simon G
authors.initials: SG
authors.lastname: Anderson
authors.affiliation: Blackpool Teaching Hospitals NHS Foundation Trust , Blackpool , UK.
authors.forename: Izhar
authors.initials: I
authors.lastname: Hashmi
authors.affiliation: University Hospital of South Manchester NHS Foundation Trust , Wythenshawe , UK.
authors.forename: Saqib
authors.initials: S
authors.lastname: Chowdhary
authors.affiliation: Blackpool Teaching Hospitals NHS Foundation Trust , Blackpool , UK.
authors.forename: David
authors.initials: D
authors.lastname: Hesketh Roberts
authors.affiliation: Manchester Royal Infirmary, Central Manchester University NHS Foundation Trust , Manchester , UK.
authors.forename: Douglas G
authors.initials: DG
authors.lastname: Fraser
authors.affiliation: Manchester Royal Infirmary, Central Manchester University NHS Foundation Trust , Manchester , UK.
authors.forename: Ragheb
authors.initials: R
authors.lastname: Hasan
authors.affiliation: Manchester Royal Infirmary, Central Manchester University NHS Foundation Trust , Manchester , UK.
authors.forename: Vaikom S
authors.initials: VS
authors.lastname: Mahadevan
authors.affiliation: University Hospital of South Manchester NHS Foundation Trust , Wythenshawe , UK.
authors.forename: Richard
authors.initials: R
authors.lastname: Levy