Tri-score a powerful tool for comprehensive risk stratification in tricuspid regurgitation management

Abstract Background The Tri-Score is increasingly used to stratify patients with tricuspid regurgitation (TR) across different treatment modalities—including surgical and percutaneous management. This study evaluates the Tri-Score pre-intervention as a robust tool for risk stratification in TR patients. Methods A retrospective cohort of 83 patients with moderate-to-severe tricuspid regurgitation (TR) treated from 2010 onward was analyzed. Patients underwent either surgical intervention (n = 39) or percutaneous intervention (n = 44), which included TriClip, Pascal transcatheter edge-to-edge repair (TEER), and Caval valve implantation (CAVI). Tri-Score classifications (low, intermediate, and high) were assessed using Kaplan–Meier (KM) survival estimates and univariate Cox proportional hazards models. Results The KM survival curves demonstrated clear discrimination among the Tri-Score groups across all treatment modalities. The KM curves confirmed that Tri-Score effectively stratifies survival risk among low-, intermediate-, and high-risk groups in the overall pre-intervention cohort (Figure 1). The mean and standard deviation of the Tri-Score were 3.21 and 2.08, respectively. The median Tri-Score was 3.00, with first and third quartiles (Q1 = 2.00, Q3 = 4.50). Similarly, the KM curve for the pre-surgical group distinguished outcomes based on Tri-Score classification, showing good outcomes in the low- and intermediate-risk groups (Figure 2). The calculated hazard ratio for a one-unit increase in the Tri-score was 1.3 (95% CI: 1.1–1.5). Conclusions The Tri-Score is an effective prognostic tool for stratifying TR patients by survival risk in both the overall intervention and surgical cohorts. The discriminative outcomes observed in the KM analyses underscore its clinical utility in guiding treatment decisions. These results suggest that early surgical intervention in patients with a low to intermediate Tri-Score is associated with favorable surgical outcomes.