This retrospective analysis of the AMTRAC registry evaluated 3,766 patients with severe aortic stenosis undergoing transcatheter aortic valve implantation across 16 centers (2013–2024). Patients were categorized by aortic valve calcium score (AVCS) into low, high, or very-high groups.
The primary outcome was all-cause mortality at 3 years; secondary outcomes included periprocedural events per VARC-3 and post-TAVI hemodynamics. At 3 years, mortality followed a bimodal pattern across the AVCS spectrum: 30.5% in the low AVCS group, 26.5% in the high AVCS group, and 31.3% in the very-high AVCS group (P<0.05).
Paravalvular leak greater than moderate increased with AVCS severity (low 0.5%, high 0.9%, very-high 1.9%; P<0.01). The very-high AVCS group had higher rates of stroke (4.1% vs 1.4% in low and 2.4% in high) and permanent pacemaker implantation (21.2% vs 14.7% in low and 14.2% in high; P<0.05 for both).
Low AVCS identified a phenotype with predominant fibrosis, more advanced symptoms, and higher mortality despite fewer procedural complications. Very-high AVCS associated with higher procedural risk, more bicuspid valves, and increased mortality.
Aortic Valve Calcium Score Spectrum and Transcatheter Outcomes: A Pragmatic View from AMTRAC