A Score to Assess Mortality After Percutaneous Mitral Valve Repair

Sergio Raposeiras-Roubin*, Marianna Adamo, Xavier Freixa, Dabit Arzamendi, Tomas Benito-González, Antonio Montefusco, Isaac Pascual, Luis Nombela-Franco, Josep Rodes-Cabau, Mony Shuvy, Antonio Portolés-Hernández, Cosmo Godino, Berenice Caneiro-Queija, Laura Lupi, Ander Regueiro, Chin Hion Li, Felipe Fernández-Vázquez, Simone Frea, Pablo Avanzas, Gabriela Tirado-ConteJean Michel Paradis, Alona Peretz, Vanessa Moñivas, Jose A. Baz, Michele Galasso, Luca Branca, Laura Sanchís, Lluís Asmarats, Carmen Garrote-Coloma, Filippo Angelini, Victor León, Eduardo Pozo, Alberto Alperi, Ronen Beeri, Dario Cani, Manel Sabaté, Estefanía Fernández-Peregrina, Javier Gualis, Pier Paolo Bocchino, Salvatore Curello, Emad Abu-Assi, Andrés Íñiguez-Romo, Francesco Bedogni, Antonio Popolo Rubbio, Luca Testa, Carmelo Grasso, Rodrigo Estévez-Loureiro

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

42 Scopus citations

Abstract

Background: Risk stratification for transcatheter edge-to-edge mitral valve repair (TEER) is paramount in the decision-making process for treating severe mitral regurgitation (MR). Objectives: This study sought to create and validate a user-friendly score (MitraScore) to predict the risk of mortality in patients undergoing TEER. Methods: The derivation cohort was based on a multicentric international registry that included 1,119 patients referred for TEER between 2012 and 2020. Score discrimination was assessed using Harrell's c-statistic, and the calibration was evaluated with the Gronnesby and Borgan goodness-of-fit test. An external validation was carried out in 725 patients from the GIOTTO registry. Results: After multivariate analysis, we identified 8 independent predictors of mortality during the follow-up (2.1 ± 1.8 years): age ≥75 years, anemia, glomerular filtrate rate <60 mL/min/1.73 m2, left ventricular ejection fraction <40%, peripheral artery disease, chronic obstructive pulmonary disease, high diuretic dose, and no therapy with renin-angiotensin system inhibitors. The MitraScore was derived by assigning 1 point to each independent predictor. The c-statistic was 0.70. Per each point of the MitraScore, the relative risk of mortality increased by 55% (HR: 1.55; 95% CI: 1.44-1.67; P < 0.001). The discrimination and calibration for mortality prediction was better than those of EuroSCORE II (c-statistic 0.61) or Society of Thoracic Surgeons score (c-statistic 0.57). The MitraScore maintained adequate performance in the validation cohort (c-statistic 0.66). The score was also predictive for heart failure rehospitalization and was correlated with the probability of clinical improvement. Conclusions: The MitraScore is a simple prediction algorithm for the prediction of follow-up mortality in patients treated with TEER.

Original languageAmerican English
Pages (from-to)562-573
Number of pages12
JournalJournal of the American College of Cardiology
Volume79
Issue number6
DOIs
StatePublished - 15 Feb 2022

Bibliographical note

Publisher Copyright:
© 2022 American College of Cardiology Foundation

Keywords

  • mortality
  • score
  • transcatheter edge-to-edge mitral valve repair
  • Follow-Up Studies
  • Humans
  • Risk Factors
  • Male
  • Stroke Volume/physiology
  • Treatment Outcome
  • Mitral Valve/surgery
  • Heart Valve Prosthesis Implantation/adverse effects
  • Mitral Valve Insufficiency/mortality
  • Time Factors
  • Cardiac Catheterization/adverse effects
  • Italy/epidemiology
  • Postoperative Complications/mortality
  • Female
  • Registries
  • Aged
  • Retrospective Studies

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