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A Score to Assess Mortality After Percutaneous Mitral Valve Repair
Sergio Raposeiras-Roubin1, Marianna Adamo2, Xavier Freixa3
1Hospital Álvaro Cunqueiro, Vigo, Spain.
Journal of the American College of Cardiology
|February 11, 2022
Summary
A new MitraScore predicts mortality risk in patients undergoing transcatheter edge-to-edge mitral valve repair (TEER). This simple score improves upon existing methods for better patient risk stratification in severe mitral regurgitation treatment.
Area of Science:
- Cardiovascular Medicine
- Interventional Cardiology
- Medical Informatics
Background:
- Accurate risk stratification is crucial for patients undergoing transcatheter edge-to-edge mitral valve repair (TEER) for severe mitral regurgitation (MR).
- Existing risk scores may not fully capture mortality risk in this specific patient population.
Purpose of the Study:
- To develop and validate a user-friendly scoring system, termed MitraScore, for predicting mortality risk in patients undergoing TEER.
- To compare the performance of the MitraScore against established risk calculators like EuroSCORE II and the Society of Thoracic Surgeons score.
Main Methods:
- A multicentric international registry of 1,119 patients undergoing TEER (2012-2020) was used for score derivation.
- Statistical analysis included multivariate analysis to identify independent predictors of mortality, Harrell's c-statistic for discrimination, and the Gronnesby and Borgan test for calibration.
- External validation was performed using data from 725 patients in the GIOTTO registry.
Main Results:
- Eight independent predictors of mortality were identified: advanced age (≥75 years), anemia, reduced glomerular filtration rate (<60 mL/min/1.73 m²), low left ventricular ejection fraction (<40%), peripheral artery disease, COPD, high diuretic dose, and lack of renin-angiotensin system inhibitor therapy.
- The MitraScore demonstrated good discrimination (c-statistic 0.70 in derivation, 0.66 in validation) and outperformed EuroSCORE II (0.61) and STS score (0.57).
- Each point increase in the MitraScore correlated with a 55% increase in mortality risk (HR: 1.55) and predicted heart failure rehospitalization.
Conclusions:
- The MitraScore is a simple and effective algorithm for predicting long-term mortality in patients undergoing TEER.
- This score offers improved risk stratification compared to existing tools, aiding clinical decision-making for severe MR treatment.
- The MitraScore's predictive capability extends to heart failure rehospitalization and clinical improvement probability.
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