Preoperative risk model and nomogram for 30‑Day mortality after TAVR: development and internal validation in a Chinese cohort.

BACKGROUND: Accurate prediction of 30‑day mortality after transcatheter aortic valve replacement (TAVR) remains challenging. Existing models often overlook key preoperative laboratory variables. We aimed to develop and internally validate a preoperative risk prediction model using routinely available variables measured before the procedure.We state that predictors were preoperative‑only. METHODS: We retrospectively analyzed 1,673 consecutive patients who underwent TAVR at Fuwai Hospital between 2013 and 2023. Patients were randomly split into a training cohort (n = 1,171) and an internal hold out validation cohort (n = 502). Candidate predictors were prespecified as routinely available preoperative variables. All candidate predictors, including laboratory parameters (troponin, D‑dimer, HbA1c, uric acid, etc.), were collected during the preoperative evaluation, within 3 days prior to the TAVR procedure. Independent predictors of 30-day mortality were identified using multivariable logistic regression. Performance was assessed with receiver operating characteristic (ROC) analysis, calibration assessment (calibration plots and Hosmer Lemeshow test), and bootstrap optimism correction; a nomogram was constructed from the final model. RESULTS: 30-day mortality was 3.4% in both the training (40/1,171) and validation (17/502) cohorts. The final preoperative model retained STS score, HbA1c, D-dimer, and uric acid as independent predictors. Discrimination was good (AUC=0.84 in the training cohort; AUC=0.78 in the internal validation cohort), with acceptable calibration (Hosmer-Lemeshow p = 0.211); optimism corrected performance closely matched the hold out out results. The resulting nomogram provides individualized risk estimates for 30-day mortality based on these preoperative predictors. CONCLUSIONS: We developed and internally validated a parsimonious preoperative risk model and nomogram for 30-day mortality after TAVR using routinely available clinical and laboratory variables. This tool may support individualized risk stratification in elective/non salvage TAVR candidates. External validation particularly beyond East-Asian populations is essential before broader application.