# Hemoglobin-Geriatric Nutritional Risk Index Predicts Major Adverse Cardiovascular Events After Transcatheter Aortic Valve Implantation

## TL;DR

A new index combining hemoglobin and nutritional risk helps predict heart problems after a common valve procedure in older patients.

## Contribution

The Hemoglobin-Geriatric Nutritional Risk Index (H-GNRI) is introduced as a novel predictor of post-TAVI cardiovascular events.

## Key findings

- Low H-GNRI scores correlate with higher rates of major adverse cardiovascular events after TAVI.
- Procedure time and hospital stay length also significantly influence postoperative outcomes.
- Kaplan-Meier and Cox analyses confirm H-GNRI as a strong independent predictor of MACEs.

## Abstract

Background/Objectives: Numerous older patients undergo transcatheter valve implantation (TAVI) and frequently experience preoperative malnutrition and anemia, which markedly influence postoperative outcomes. This study investigated whether the Hemoglobin-Geriatric Nutritional Risk Index (H-GNRI) could predict major adverse cardiovascular events (MACEs) after TAVI. Methods: Patients who underwent TAVI at a single institution were classified into three groups according to their H-GNRI scores: low-risk (H-GNRI score = two), intermediate-risk (H-GNRI score = one), and high-risk (H-GNRI score = zero). The primary outcome was the occurrence of MACEs post-TAVI, and Kaplan–Meier survival and Cox proportional-hazard analyses were performed. Results: Of the 205 patients analyzed, 123, 67, and 15 were assigned H-GNRI scores of two, one, and zero. Kaplan–Meier survival analysis revealed that patients with H-GNRI scores of one and zero developed significantly more MACEs than those with a score of two (log-rank p = 0.0030; 1 vs. 2, p = 0.0032; 0 vs. 2, p = 0.0077). In the Cox proportional-hazard analysis, factors associated with MACEs included H-GNRI score (using score two as reference; score one: hazard ratio [HR] = 2.02, 95% confidence interval [CI] = 1.10–3.60, p = 0.021; score 0: HR = 2.67, 95% CI = 1.10–6.44, p = 0.028), procedure time (HR = 1.00; 95% CI = 1.00–1.01; p = 0.0093), and length of hospital stay after TAVI (HR = 1.02; 95% CI = 1.01–1.04, p = 0.0003). Conclusions: Preoperative H-GNRI scores were markedly associated with the incidence of postoperative MACEs in patients undergoing TAVI.