Clinical clustering of TAVI patients: multivariate profiling and outcome associations using two-step cluster analysis

To the Editor, Transcatheter aortic valve implantation (TAVI) has revolutionized the management of severe aortic stenosis (AS).1 Despite increasing TAVI experience and procedural improvement, outcomes remain hard to foresee.1 Several clinical and anatomical risk factors have been well established as independent predictors of adverse events.2 Nonetheless, the macro-level interactions between them are complex and challenging to quantify with traditional models, particularly given the dynamic clinical trajectory of AS. Although standardized risk scores, such as the Society of Thoracic Surgeons (STS) score and the EuroSCORE II offer estimates of procedural risk3 they miss the broader clinical profile and interactions. Advanced statistical techniques, such as multivariate cluster analysis, can identify subgroups, potentially uncovering patterns overlooked by conventional risk stratification. This study aimed to stratify TAVI patients using a 2-step cluster analysis based on clinical and risk factor variables and evaluate the association between these clusters and procedural timing and clinical outcomes. We conducted a retrospective, single-center study with 300 patients undergoing TAVI from 2020 through 2023, without immediate cardiac surgery back-up. Data were retrospectively analyzed. Procedural and outcome definitions followed the Valve Academic Research Consortium-3 criteria.4 A 2-step cluster analysis was performed, incorporating variables such as age, sex, New York Heart Association (NYHA) functional class,...