Elixhauser Comorbidity Score Is the Best Risk Score in Predicting Survival After Mitraclip Implantation

<b>Background:</b> Risk scores to assess life expectancy may be beneficial in clinical decision making in selecting frail patients for MitraClip implantation according to the guidelines. This study was conducted to determine the risk score that performs best in predicting 1-year survival in patients undergoing percutaneous mitral valve repair using the MitraClip. <b>Method:</b> All consecutive patients who underwent a MitraClip implantation between May 2009 and May 2016 were enrolled. The STS-PROM score, EuroSCORE I, EuroSCORE II, ACEF, Charlson comorbidity score, Elixhauser comorbidity score, Guaragna score, OBSERVANT score and Ambler score were calculated. The capacity to discriminate between 1-year survival and 1-year mortality was assessed by the area under the receiver operating characteristic (ROC) curve (c statistic). <b>Results:</b> In the study 152 patients were included, 52% was male and the median age was 78 (interquartile range 69–83). Primary MR was present in 64% of the patients. On average, 1.5 MitraClips were implanted without any procedural mortality. The overall 1-year survival of this cohort was 80%. The Elixhauser comorbidity score showed the largest area under the ROC curve of 0.75 (95% confidence interval: 0.66–0.84). The other tests showed a smaller area under the ROC curve ranging from 0.51 (Guaragna score) to 0.72 (Charlson comorbidity score). <b>Conclusion:</b> The Elixhauser comorbidity score has the best performance in predicting 1-year survival after MitraClip implantation. Therefore, the Elixhauser risk score should be used for making an assessment of 1-year mortality when selecting patients for treatment with the MitraClip.

<b>背景：</b> 用于评估预期寿命的风险评分，可为临床决策提供重要支撑，助力指南推荐的经导管二尖瓣夹（MitraClip）植入术的衰弱患者筛选流程。本研究旨在明确在接受MitraClip行经皮二尖瓣修复术的患者中，预测1年生存率表现最优的风险评分模型。<b>方法：</b> 本研究纳入2009年5月至2016年5月期间连续收治的接受MitraClip植入术的全部患者。计算各患者的胸外科医师学会预测风险评分（STS-PROM）、欧洲心脏手术风险评估系统Ⅰ（EuroSCORE Ⅰ）、欧洲心脏手术风险评估系统Ⅱ（EuroSCORE Ⅱ）、ACEF评分、查尔森合并症指数（Charlson comorbidity score）、伊利豪泽合并症指数（Elixhauser comorbidity score）、瓜尔格纳评分（Guaragna score）、OBSERVANT评分以及安布勒评分（Ambler score）。采用受试者工作特征（Receiver Operating Characteristic, ROC）曲线下面积（即c统计量）评估各评分区分1年生存与1年死亡的效能。<b>结果：</b> 本研究共纳入152例患者，其中男性占比52%，患者年龄中位数为78岁（四分位间距69~83岁）。64%的患者存在原发性二尖瓣反流（Mitral Regurgitation, MR）。平均每例患者植入1.5个MitraClip夹，无操作相关死亡发生。该队列患者的总体1年生存率为80%。其中，伊利豪泽合并症指数的ROC曲线下面积最大，达0.75（95%置信区间：0.66~0.84）；其余评分的ROC曲线下面积介于0.51（瓜尔格纳评分）至0.72（查尔森合并症指数）之间。<b>结论：</b> 伊利豪泽合并症指数在预测MitraClip植入术后1年生存率方面表现最优。因此，在筛选适合接受MitraClip治疗的患者时，应采用伊利豪泽合并症风险评分评估患者1年死亡风险。