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Score to Assess Mortality After Percutaneous Mitral Valve Repair
Quick Takes
- The MitraScore score is a simple eight-variable algorithm for the prediction of mortality in patients treated with TEER.
- Higher score modestly predicted death and functional class post-procedure.
- Although ease of use is attractive for clinical application, prospective validation is still needed.
Study Questions:
Can a user-friendly score help predict the risk of mortality in patients undergoing transcatheter edge-to-edge mitral valve repair (TEER)?
Methods:
The derivation cohort was based on a multicentric international registry that included 1,119 patients referred for TEER between 2012–2020. 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, the authors identified eight independent predictors of mortality during the follow-up (2.1 ± 1.8 years): age ≥75 years, anemia, glomerular filtrate rate <60 mL/min/m2, left ventricular ejection fraction (LVEF) <40%, peripheral arterial disease, chronic obstructive pulmonary disease (COPD), high diuretic dose, and no therapy with renin-angiotensin system inhibitors. The MitraScore was derived by assigning one 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% (hazard ratio, 1.55; 95% confidence interval, 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 (STS) 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.
Perspective:
Adequate prediction of post-procedure survival after TEER has remained elusive. Although several scores have been tested, overall accuracy has been low. The current study introduces the MitraScore as an easy way to estimate risk of mortality and functional class improvement among patients undergoing TEER. The score used eight easily identified variables (age ≥75 years, anemia, glomerular filtrate rate <60 mL/min/m2, LVEF <40%, peripheral arterial disease, COPD, high diuretic dose, and no therapy with renin-angiotensin system inhibitors) to calculate a MitraScore with one point assigned to each risk factor. The score outperformed more commonly used models such as EuroSCORE II and STS score; however, overall discrimination remained modest. Although ease of use is attractive for clinical application, prospective validation is still needed.
Clinical Topics: Cardiac Surgery, Cardiovascular Care Team, Geriatric Cardiology, Heart Failure and Cardiomyopathies, Invasive Cardiovascular Angiography and Intervention, Valvular Heart Disease, Atherosclerotic Disease (CAD/PAD), Cardiac Surgery and Heart Failure, Cardiac Surgery and VHD, Acute Heart Failure, Interventions and Structural Heart Disease, Interventions and Vascular Medicine, Mitral Regurgitation
Keywords: Anemia, Cardiac Surgical Procedures, Diuretics, Geriatrics, Glomerular Filtration Rate, Heart Failure, Mitral Valve Insufficiency, Peripheral Arterial Disease, Pulmonary Disease, Chronic Obstructive, Renin-Angiotensin System, Risk Factors, Stroke Volume, Transcatheter Aortic Valve Replacement, Ventricular Function, Left
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