Key result
Conventional surgical risk scores overestimated periprocedural mortality (observed 3.5% vs predicted 9.6-23.1%) and did not significantly predict 30-day mortality in high-risk patients undergoing percutaneous mitral valve repair.
Why the study?
Do conventional surgical risk scores accurately predict periprocedural mortality in high-risk patients undergoing percutaneous edge-to-edge mitral valve repair?
Observational (n=136)
No
Do conventional surgical risk scores accurately predict periprocedural mortality in high-risk patients undergoing percutaneous edge-to-edge mitral valve repair?
Effect estimate: AUC 0.65 (95% CI 0.49-0.81)
Absolute Event Rate: 13.2% vs 3.5%
p-value: p=0.25
Conventional surgical risk scores overestimate mortality and have poor predictive value for periprocedural mortality in patients undergoing percutaneous edge-to-edge mitral valve repair.
BACKGROUND: Surgical risk scores are used to identify high-risk patients for surgical mitral valve repair. There is no scoring system to estimate the mortality risk for patients undergoing percutaneous treatment. The aim of this analysis is to evaluate the predictive value of the EuroSCOREs and the Society of Thoracic Surgeons Predicted Risk of Mortality Score (STS) for periprocedural mortality in percutaneous edge-to-edge mitral valve repair. METHODS: From 2009 to 2013, 136 high-risk patients were included who underwent 143 procedures. Observed periprocedural mortality was compared with predicted mortality using the logistic EuroSCORE, EuroSCORE II and STS. The predictive value was analysed by receiver operating characteristic curves for each score. RESULTS: Observed periprocedural mortality was 3.5 %. The predicted surgical mortality risk was: 23.1 ± 15.7 % for the logistic EuroSCORE, 9.6 ± 7.7 % for the EuroSCORE II and 13.2 ± 8.2 % for the STS. The predictive value estimated by the area under the curve was: 0.55, 0.54 and 0.65 for the logistic EuroSCORE, EuroSCORE II and STS respectively. Severe pulmonary hypertension and acute procedural success were significant predictive parameters in univariate analysis. CONCLUSION: Contemporary surgical scores do not adequately predict periprocedural mortality for high-risk patients undergoing edge-to-edge mitral valve repair, but they can be used to help decision-making in the selection process for this procedure.
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Kortlandt et al. (2016) conducted an observational in Mitral regurgitation (n=136). Conventional surgical risk scores (logistic EuroSCORE, EuroSCORE II, STS) vs. Observed periprocedural mortality was evaluated on Predictive value for periprocedural mortality (30-day or in-hospital death) (AUC 0.65, 95% CI 0.49-0.81, p=0.25). Conventional surgical risk scores overestimated periprocedural mortality (observed 3.5% vs predicted 9.6-23.1%) and did not significantly predict 30-day mortality in high-risk patients undergoing percutaneous mitral valve repair.
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