Predictive performance of the TRI-SCORE in patients with severe aortic stenosis and concomitant tricuspid regurgitation undergoing TAVR.

Background: Tricuspid regurgitation (TR) is a common comorbidity in patients with severe aortic stenosis (AS) undergoing transcatheter aortic valve replacement (TAVR) and represents a significant predictor of adverse outcomes. Precise risk stratification through clinical scoring systems is vital for tailoring treatment decisions in this patient population.

Objectives: To assess the applicability of the TRI-SCORE for predicting adverse outcomes in patients with AS and concomitant moderate-to-severe TR undergoing TAVR and to compare its performance with established surgical risk scores like the EuroSCORE II and Society of Thoracic Surgeons score (STS-Score).

Methods: We conducted a retrospective analysis of 301 patients with severe AS and concomitant TR who underwent TAVR between 2013 and 2022 at the Heart Center Bonn. According to the TRI-SCORE, patients were stratified into a low or intermediate-risk group (TRI-SCORE 0-5) and a high-risk group (TRI-SCORE 6-12). The primary endpoint was 2-year all-cause mortality. Predictive values of the TRI-SCORE were compared to the EuroSCORE II and the STS-Score for both 30-day and 2-year mortality outcomes.

Results: The 2-year mortality rate was significantly higher in the high-risk group compared to the low or intermediate-risk group (TRI-SCORE 6-12: 40.0% vs. TRI-SCORE 0-5: 17.9%; p < 0.001). For predicting 30-day mortality, the EuroSCORE II and the STS-Score demonstrated superior predictive values, with AUCs of 78.4% and 83.0%, respectively, in comparison to the TRI-SCORE, which showed an AUC of 70.0%. Conversely, the TRI-SCORE allowed a better risk prediction with regard to 2-year all-cause mortality, achieving an AUC of 69.7%, superior to the EuroSCORE II (60.6%) and the STS-Score (62.1%).

Conclusion: The TRI-SCORE is effective in predicting mid-term mortality in patients with AS and moderate-to-severe TR undergoing TAVR, demonstrating greater robustness than the EuroSCORE II and the STS-Score for this timeframe.