Çağatay Tunca, Reha Yasin Şengül, Ahsen Özge Akpınar, Fatih Cihat Büyükbaş, Mehmet Taha Özkan, Özgür Ulaş Özcan, Veysel Ozan Tanık, Bülent Özlek
The HATCH score independently predicted NOAF after transfemoral TAVI and performed at least as well as the CHA2DS2-VASc score; aortic root angulation was an additional independent correlate. As a simple, bedside tool, the HATCH score may aid pre-procedural risk stratification, pending external validation.
BACKGROUND: New-onset atrial fibrillation (NOAF) is a frequent complication after transcatheter aortic valve implantation (TAVI) and is associated with adverse outcomes, yet simple pre-procedural tools to identify at-risk patients are limited. The HATCH score predicts incident atrial fibrillation in other settings but has not been evaluated in TAVI. We assessed whether the HATCH score predicts NOAF after transfemoral TAVI and compared it with the CHA2DS2-VASc score.
METHODS: In this retrospective single-center study, 268 patients in sinus rhythm who underwent transfemoral TAVI for severe aortic stenosis between October 2022 and January 2026 were included. NOAF was defined as atrial fibrillation or flutter lasting ≥ 30 s during the index hospitalization. Independent predictors were identified by multivariable logistic regression; discrimination was assessed by the area under the receiver operating characteristic curve (AUC), compared using the DeLong test, and internally validated by bootstrapping.
RESULTS: NOAF occurred in 44 patients (16.4%). The HATCH score was higher in the NOAF group (2.75 ± 0.81 vs. 2.03 ± 0.85; p < 0.001). On multivariable analysis, the HATCH score (adjusted odds ratio [OR] 2.69, 95% CI 1.75-4.13; p < 0.001) and aortic root angulation (adjusted OR 1.05 per degree, 95% CI 1.02-1.09; p = 0.002) were independent predictors of NOAF. The HATCH score yielded an AUC of 0.730 (95% CI 0.672-0.782), numerically higher than that of the CHA2DS2-VASc score (0.668, 95% CI 0.608-0.724), although the difference was not significant (p = 0.216); a HATCH score ≥ 3 provided 63.6% sensitivity and 77.7% specificity. The optimism-corrected C-statistic was 0.761 with a calibration slope of 0.918. NOAF was associated with a higher rate of in-hospital stroke (15.9% vs. 3.6%; p = 0.005).
CONCLUSIONS: The HATCH score independently predicted NOAF after transfemoral TAVI and performed at least as well as the CHA2DS2-VASc score; aortic root angulation was an additional independent correlate. As a simple, bedside tool, the HATCH score may aid pre-procedural risk stratification, pending external validation.