Abstract 4363442: Old Tool, New Tricks: Elevated RCRI Scores Signal Higher Risk Following TAVR

Introduction: The Revised Cardiac Risk Index (RCRI) is a validated tool used to predict the risk of adverse cardiac events in non-cardiac surgeries. It assigns one point for each of six risk factors: high-risk surgery, ischemic heart disease, heart failure, cerebrovascular disease, insulin-dependent diabetes, and serum creatinine >2.0 mg/dL. Scores are categorized as minimal (0), low (1), intermediate (2), and high risk (≥3), with greater scores correlating with greater risk of adverse events. The utility of RCRI in predicting risk for non-invasive cardiac procedures such as transcatheter aortic valve replacement (TAVR) has not been established. Hypothesis: We hypothesize that higher RCRI scores correlate with increased post-TAVR adverse events. Methods: We performed a retrospective cohort analysis of TAVR patients at an academic medical center (2018-2024). RCRI score was calculated using chart-abstracted comorbidities on a scale of 0-5 as TAVR was assessed as a low-risk procedure. Patients were then stratified into the four risk groups based on RCRI score. Mortality was the primary outcome. 30-day rehospitalizations, major adverse cardiac events (MACE), and post-procedural complications evaluated at 30 days, 6 months, and 12 months were secondary outcomes. Chi-squared tests and logistic regressions were used to assess associations across strata. Results: Of 298 patients, 18.1% were minimal risk, 34.9% low, 34.2% intermediate, and 12.8% high risk. Mortality was greater in high-risk (23.1%) compared to the minimal-risk patients (5.6%; p = 0.02). 30-day rehospitalizations were also more frequent in high-risk groups (p <0.001). There was a statistically significant increase in composite MACE (p = 0.005), cerebrovascular accidents (p = 0.0008), conduction abnormalities (p = 0.01), and heart failure exacerbations (p = 0.026) across strata at 6 months post-procedure. Each of these associations remained statistically significant at 12 months. There were no significant differences in race (p = 0.13) or gender (p = 0.20) across RCRI groups. Conclusions: While TAVR is generally well-tolerated, the RCRI may serve as a valuable tool for preprocedural risk stratification. It may aid in clinical decision-making and patient counseling, particularly when discussing the risks and benefits of the procedure with high-risk individuals, as well as provide opportunities for improved medical optimization prior to the procedure.