Prognostic Impact of Modified J‐MACS Score in Patients With Systolic Heart Failure Receiving Transcatheter Edge‐to‐Edge Mitral Valve Repair

Background Given the relatively high morbidity and death associated with transcatheter edge‐to‐edge repair for secondary mitral regurgitation, the development of optimal risk stratification models is imperative. The J‐MACS (Japanese Registry for Mechanically Assisted Circulatory Support) score is a recently developed tool designed to stratify risk in patients with advanced heart failure undergoing durable left ventricular assist device implantation. Methods Data were obtained from the OCEAN‐Mitral (Optimized Catheter Valvular Intervention–Mitral) registry on patients with secondary mitral regurgitation and left ventricular ejection fraction <50% who underwent transcatheter edge‐to‐edge repair. A newly innovated modified J‐MACS score, incorporating age, history of cardiac surgery, serum creatinine levels, and postprocedural moderate or greater tricuspid regurgitation, was calculated. Its prognostic significance regarding the primary outcome, comprising all‐cause death and heart failure–related hospitalizations, was assessed. Results A total of 2006 patients (median age, 77 years; 63% men) were included in the study. The median modified J‐MACS score was 13.7 (interquartile range, 12.0–16.2). Based on statistically calculated optimal cutoff values of 11.4 and 14.0, patients were stratified into 3 risk categories: low, moderate, and high. The 2‐year cumulative incidence of the primary outcome differed significantly among these groups (26%, 37%, and 51%, respectively; P <0.001). Risk group classification remained independently associated with the primary outcome, with an adjusted hazard ratio of 1.42 (95% CI, 1.13–1.71; P <0.001) for the intermediate risk versus low risk and 2.27 (95% CI, 1.67–2.96; P <0.001) for the high risk versus low risk. Conclusions The modified J‐MACS score demonstrated an independent association with all‐cause death and heart failure–related hospitalization following transcatheter edge‐to‐edge repair in patients with significant mitral regurgitation and systolic heart failure. Registration URL: https://upload.umin.ac.jp ; Unique Identifier: UMIN000023653.