Abstract 4363442: Old Tool, New Tricks: Elevated RCRI Scores Signal Higher Risk Following TAVR
Abstract
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.
Article Details
Authors (40)
Pal Shah
University of Illinois Chicago, Chicago, Illinois, United States
Savina Sahgal
University of Illinois Chicago, Plainfield, Illinois, United States
Atreya Mishra
University of Illinois Chicago, Plainfield, Illinois, United States
Andrew Carlson
University of Illinois Chicago, Chicago, Illinois, United States
Siddharth Bhayani
University of Illinois Chicago, Chicago, Illinois, United States
Suhas Seshadri
University of Illinois-Chicago, Chicago, Illinois, United States
Raghav Matta
University of Illinois Chicago, Chicago, Illinois, United States
Azmer Khan
University of Illinois Chicago, Chicago, Illinois, United States
Rohan Bhattaram
University of Illinois Chicago, Chicago, Illinois, United States
Runze Zhang
Drug Discovery and Design Center, State Key Laboratory of Drug Research, Shanghai Institute of Materia Medica, Chinese Academy of Sciences
Aanya Roy
University of Illinois Chicago, Chicago, Illinois, United States
Bayan Hammad
University of Illinois Chicago, Chicago, Illinois, United States
Arvind Draffen
University of Illinois Chicago, Chicago, Illinois, United States
Zachary Natsheh
University of Illinois Chicago, Chicago, Illinois, United States
Daniel Tiu
University of Illinois Chicago, Plainfield, Illinois, United States
David Tiu
University of Illinois Chicago, Plainfield, Illinois, United States
Edward Salem
University of Illinois Chicago, Chicago , Illinois, United States
Jesse Balami
University of Illinois Chicago, Chicago, Illinois, United States
Nonye Uche
University of Illinois Chicago, Chicago, Illinois, United States
Swetha Kalagara
University of Illinois Chicago, Chicago, Illinois, United States
Neil Gupta
University of Illinois Chicago, Chicago , Illinois, United States
Adriana Ene
University of Illinois Chicago, Chicago, Illinois, United States
Aleyah Hattab
University of Illinois Chicago, Plainfield, Illinois, United States
Aarushi Arora
University of Illinois Chicago, Chicago, Illinois, United States
Humam Sufyaan
University of Illinois Chicago, Chicago, Illinois, United States
Jennifer Dau
University of Illinois Chicago, Chicago, Illinois, United States
Jonathan Silberstein
University of Illinois Chicago, Chicago, Illinois, United States
Julia Yu
University of Illinois Chicago, Chicago, Illinois, United States
Kayla Torres
University of Illinois Chicago, Chicago, Illinois, United States
Laura Navarro
University of Illinois Chicago, Plainfield, Illinois, United States
Manisha Singam
University of Illinois Chicago, Plainfield, Illinois, United States
Mariam Ismail
Department of Chemistry, Hunter College
Riya Rana
University of Illinois Chicago, Chicago, Illinois, United States
Samer Habeel
University of Connecticut, Farmington, Connecticut, United States
Simon Liu
University of Illinois Chicago, Chicago, Illinois, United States
Srinidhi Chaganti
University of Illinois Chicago, Chicago, Illinois, United States
Vidur Gurbuxani
University of Illinois Chicago, Chicago, Illinois, United States
Stephanie Dwyer Kaluzna
University of Illinois Chicago, Chicago, Illinois, United States
Vicki Groo
University of Illinois Chicago, Plainfield, Illinois, United States
Adhir Shroff
University of Illinois Chicago, Plainfield, Illinois, United States