Using ATRIA score in patients with transcatheter aortic valve implantation due to severe aortic stenosis for risk stratification

Using ATRIA Score in Patients with Transcatheter Aortic Valve Implantation due to Severe Aortic Stenosis for Risk Stratification Ankara Yıldırım Beyazıt University Department of Cardiology, Ataturk Education and Research Hospital, Cardiology Thesis. Ankara, 2019 Background and Aim: The frequency of transcatheter aortic valve implantation (TAVI) is increasing as a result of increased mean life expectancy and the expansion of the indication of the procedure. However, in current guidelines and studies, there is no gold standard risk scoring that determines which patient eligible for surgical aortic valve replacement (SAVR) or eligible for TAVI. Currently various risk scores are used together. Because TAVI is applied to patients whose life expectancy is more than a year and who are expected to improve their quality of life after the procedure, risk classification is very important in determining optimal candidates. The aim of this study is; to demonstrate the availability of a simple, inexpensive and feasible ATRIA score in order to perform a stronger risk assessment due to the inadequacy of current risk scores in patients who are planned undergo TAVI. Materials And Methods: In this study, 303 patients who were diagnosed as symptomatic severe AD between July 2011 and September 2018 and who were accepted as moderate and high risk or inoperable for the SAVR by the heart team due to comorbid reasons and who underwent TAVI procedure were taken retrospectively. The demographic data, laboratory results and other clinical information of the patients included in the study were obtained from the archive files. EUROSCORE, STS, ATRIA, HASBLED AND CHA₂DS CH-VASc scores were calculated from web based system. Results: The patients with ATRIA score 0-6 were assigned to the low-intermediate risk group and those over 7 were included in the high-risk group. There were n=92 (30.4%) patients in the low-intermediate risk group and n=211 (69.6%) patients in the high-risk group. The mean age of the patients in the low-intermediate ix risk group was 70.11 ± 7.32 years, while in the high-risk group it was 80.53 ± 6.05 years. When the risk scores of the study population were examined, the mean of EuroSCORE Ⅰ was 13.69 ± 4.84, the mean of EuroSCORE Ⅱ was 9.02 ± 5.82, the mean of STS was 6.19 ± 3.60, the mean of CHA₂DS₂-VASc was 4.15 ± 1.33, the mean of HASBLED was 2.25 ± 0.65 and the mean of ATRIA was 7.25 ± 2.17. In the compatibility analysis, the kappa coefficients were found to be 0.26.0.28 and 0.30 for EuroSCORE Ⅰ, EuroSCORE Ⅱ and STS, respectively. As a result, there was a weak but statistically significant correlation between ATRIA and other risk scores (p <0.001). In our study, tamponade was observed as 1.9%. All of the patients who developed cardiac tamponade (n = 6) were in the high risk group of ATRIA. Also, ATRIA high risk group could not be associated with peri-procedural complications such as first year mortality, permanent pacemaker implantation, cardiac tamponade, major vascular complication and paravalvular aortic regurgitation. 30-day mortality was observed in 25 (8.2%) patients, 3 of them were in the low-intermediate risk group and 22 were in the high-risk group A, statistically significant difference was observed in terms of 30-day mortality on the basis of ATRIA groups (p = 0.037). Also In multivariate analysis, high ATRIA score reached statistical significance in predicting 30-day mortality (p = 0.001). Conclusion: In our study, it was shown that in patients who underwent transcatheter aortic valve implantation due to severe aortic stenosis, the ATRIA score could be used in risk assessment in TAVI patients, similar to conventional risk scores, because it could show 30-day complications and mortality consistent with current risk scores. In order for our current findings to change daily practice, larger scale studies are needed. Keywords: Severe Aortic Stenosis, Risk stratification, ATRIA, Transcatheter Aortic Valve Implantation