Can Coronary Complexity Improve Risk Prediction in Transcatheter Aortic Valve Implantation? Insights from SYNTAX II Compared with Surgical Scores

Objective: Aortic stenosis (AS) is one of the most common valvular heart diseases, and transcatheter aortic valve implantation (TAVI) has become an established treatment option for patients at high surgical risk. As TAVI is increasingly performed, there is a growing need for reliable risk stratification tools to predict peri- and post-procedural outcomes. This study compared the predictive value of the Syntax Score II (SS II), commonly used in coronary artery disease, with conventional surgical risk scores – EuroSCORE and the Society of Thoracic Surgeons (STS) score; in estimating in-hospital mortality after TAVI. Methods: Seventy patients who underwent TAVI for severe AS between 2011 and 2018 at our center were included. Patients were classified according to in-hospital survival, and associations between risk scores and mortality were assessed. Results: The mean age was 77.4±10.1 years, and 58.6% of the patients were male. Univariate analysis showed that STS, EuroSCORE, SS II, left ventricular systolic diameter, and mean aortic gradient were higher in the mortality group. Post-procedural complications did not differ significantly between survivors and non-survivors (stroke, p=0.22; acute renal failure, p=0.50; pacemaker implantation, p=0.49). Multivariable regression analysis identified EuroSCORE as an independent predictor of in-hospital mortality (p=0.05), whereas STS and SS II were not statistically significant. Conclusion: Among the scores evaluated, EuroSCORE demonstrated superior predictive ability for in-hospital mortality following TAVI. Nonetheless, the findings highlight the need for novel, procedure-specific risk models tailored to TAVI populations.