title: Comparison of three contemporary surgical scores for predicting all-cause mortality of patients undergoing percutaneous mitral valve repair with the MitraClip system (from the multicenter GRASP-IT registry).
abstract: The aim of this study was to explore the adaptability of 3 contemporary surgical scores (Logistic EuroSCORE [LES], EuroSCORE II [ESII], and Society of Thoracic Surgeons Predicted Risk of Mortality [STS-PROM]) for prediction of mortality after percutaneous mitral valve repair with the MitraClip system. A total of 304 patients from the multicenter Getting Reduction of mitrAl inSufficiency by Percutaneous clip implantation in ITaly registry (GRASP-IT) were stratified based on LES, ESII, and STS-PROM tertiles and analyzed by different measurements of discrimination, calibration, and global accuracy with focus on 30-day and 1-, 2-, and 3-year mortality. A statistically significant gradient in the distribution of mortality was observed at all time points with ESII, at 2 years with LES, and at 2 and 3 years with STS-PROM. ESII had the best discrimination at 30 days (C-statistic 0.80), which remained acceptable at later follow-up, being significantly superior to that of LES at each time point (p = 0.003 at 30 days, p = 0.005 at 1 year, p = 0.011 at 2 years, and p = 0.029 at 3 years). Compared with STS-PROM, ESII showed better discrimination at 30 days (C-statistic 0.80 vs 0.62, p = 0.023). All scores overpredicted the risk of mortality at 30 days and were miscalibrated at 2 and 3 years. At 1 year, there was a good agreement between the observed and predicted probabilities for ESII and STS-PROM, whereas LES remained overpredictive. ESII showed the best global accuracy at 30 days and 1 year, whereas no notable differences were noted versus LES and STS-PROM at 2 and 3 years. In conclusion, lacking specific tools for risk stratification of patients undergoing MitraClip implantation, ESII holds favorable prognostic characteristics, which makes it a valid surrogate.
authors.affiliation: Spedali Civili, Brescia, Italy.
authors.forename: Marianna
authors.initials: M
authors.lastname: Adamo
authors.affiliation: Ferrarotto Hospital, University of Catania, Catania, Italy. Electronic address: dcapodanno@gmail.com.
authors.forename: Davide
authors.initials: D
authors.lastname: Capodanno
authors.affiliation: Ferrarotto Hospital, University of Catania, Catania, Italy.
authors.forename: Stefano
authors.initials: S
authors.lastname: Cannata
authors.affiliation: Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy.
authors.forename: Cristina
authors.initials: C
authors.lastname: Giannini
authors.affiliation: St. Ambrogio Clinical Institute, Milan, Italy.
authors.forename: Maria Luisa
authors.initials: ML
authors.lastname: Laudisa
authors.affiliation: Ferrarotto Hospital, University of Catania, Catania, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Barbanti
authors.affiliation: Spedali Civili, Brescia, Italy.
authors.forename: Salvatore
authors.initials: S
authors.lastname: Curello
authors.affiliation: Ferrarotto Hospital, University of Catania, Catania, Italy.
authors.forename: Sebastiano
authors.initials: S
authors.lastname: Immè
authors.affiliation: Spedali Civili, Brescia, Italy.
authors.forename: Diego
authors.initials: D
authors.lastname: Maffeo
authors.affiliation: Ferrarotto Hospital, University of Catania, Catania, Italy.
authors.forename: Carmelo
authors.initials: C
authors.lastname: Grasso
authors.affiliation: St. Ambrogio Clinical Institute, Milan, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Bedogni
authors.affiliation: Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy.
authors.forename: Anna Sonia
authors.initials: AS
authors.lastname: Petronio
authors.affiliation: Spedali Civili, Brescia, Italy.
authors.forename: Federica
authors.initials: F
authors.lastname: Ettori
authors.affiliation: Ferrarotto Hospital, University of Catania, Catania, Italy.
authors.forename: Corrado
authors.initials: C
authors.lastname: Tamburino
mesh_terms: D000368:Aged; D006328:Cardiac Catheterization; D002423:Cause of Death / Q000639:trends; D005260:Female; D005500:Follow-Up Studies; D019918:Heart Valve Prosthesis Implantation / Q000379:methods*; D006801:Humans; D007558:Italy / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D008944:Mitral Valve Insufficiency / Q000401:mortality / Q000601:surgery*; D011474:Prosthesis Design; D012042:Registries; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D012720:Severity of Illness Index; D015996:Survival Rate / Q000639:trends; D013997:Time Factors; D016896:Treatment Outcome