Preprocedural CALLY Index As a Novel Predictor of Pacemaker Requirement After Transcatheter Aortic Valve Replacement

IF 2.1 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

CJC Open Pub Date : 2026-08-01 Epub Date: 2026-04-03 DOI:10.1016/j.cjco.2026.03.008

Haitham Abu Khadija MD, Nizar Abu Hamdeh MD, Mohammad Masu'd MD, Duha Najajra MD, Ali Abdullah MD, Jebrin Alkrinawi MD, Alena Kirzhner MD, Zeina Sinnokrot MD, Lilian Jofa MD, Firas Besharieh MD, Rashed Saed MD, Alaa Zayed MD, Sarah Awad MD, Tal Schiller MD, Mohammad Alnees MD

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Abstract

Background

Permanent pacemaker implantation (PPI) is a common complication after transcatheter aortic valve replacement (TAVR). Although procedural and electro-anatomic factors are well established, patient-related susceptibility markers remain unclear. We aimed to evaluate whether the preprocedural C-reactive protein–albumin–lymphocyte (CALLY) index independently predicts and aids in risk stratification for 30-day PPI after TAVR.

Methods

We retrospectively analyzed 812 consecutive TAVR patients with complete baseline labs (2010-2025). The CALLY index was calculated as (albumin × lymphocytes ÷ C-reactive protein) ×10, and patients were stratified into quartiles (Q1-Q4). The primary endpoint was new PPI within 30 days. Kaplan–Meier curves and Cox regression assessed the association between CALLY index quartiles and PPI risk. Multivariable models adjusted for prespecified clinical, anatomic, and procedural factors. Subgroup analyses evaluated consistency across age, sex, hypertension, and valve type.

Results

Median time to PPI was 4 days (interquartile range 2-9), and 145 patients (17.9%) required implantation. Higher CALLY index quartiles were associated with a progressively lower PPI risk compared with Q1: Q2 hazard ratio (HR) 0.64 (95% confidence interval [CI] 0.42-0.99), Q3 HR 0.63 (95% CI 0.41-0.98), and Q4 HR 0.50 (95% CI 0.31-0.79). After multivariable adjustment, Q4 remained independently protective (HR 0.57, 95% CI 0.35-0.94). The protective effect of Q4 was consistent across subgroups, including age ≥ 80 years, male patients, female patients, hypertensive patients, and recipients of self-expanding valves. No significant effect modification was observed.

Conclusions

A higher preprocedural CALLY index was independently linked to a lower 30-day pacemaker requirement after TAVR. As a simple, inexpensive marker, the CALLY index may improve pre-TAVR risk stratification and guide periprocedural planning.

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术前CALLY指数作为经导管主动脉瓣置换术后起搏器需求的新预测指标

背景：永久性起搏器植入（PPI）是经导管主动脉瓣置换术（TAVR）后常见的并发症。虽然程序性和电解剖因素已经确定，但与患者相关的易感性标志物仍不清楚。我们的目的是评估术前c反应蛋白-白蛋白淋巴细胞（CALLY）指数是否能独立预测和帮助TAVR术后30天PPI的风险分层。方法回顾性分析812例基线检查完整的TAVR患者（2010-2025年）。计算CALLY指数为（白蛋白×淋巴细胞÷ c反应蛋白）×10，将患者分为四分位数（Q1-Q4）。主要终点为30天内新的PPI。Kaplan-Meier曲线和Cox回归评估了CALLY指数四分位数与PPI风险之间的关系。多变量模型调整预先指定的临床，解剖和程序因素。亚组分析评估了年龄、性别、高血压和瓣膜类型之间的一致性。结果到PPI的中位时间为4天（四分位数范围2-9），145例（17.9%）患者需要植入。与Q1: Q2风险比（HR） 0.64（95%可信区间[CI] 0.42-0.99）、Q3风险比0.63 （95% CI 0.41-0.98）和Q4风险比0.50 （95% CI 0.31-0.79）相比，较高的CALLY指数四分位数与PPI风险逐渐降低相关。多变量调整后，Q4仍然具有独立保护作用（HR 0.57, 95% CI 0.35-0.94）。Q4的保护作用在年龄≥80岁、男性患者、女性患者、高血压患者和自扩瓣膜受者等亚组中一致。未观察到明显的效果改变。结论术前CALLY指数升高与TAVR术后30天起搏器需求降低独立相关。作为一种简单、廉价的标志物，CALLY指数可以改善tavr前的风险分层和指导围手术期计划。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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