TY - JOUR
T1 - The MIDA Mortality Risk Score
T2 - Development and external validation of a prognostic model for early and late death in degenerative mitral regurgitation
AU - Grigioni, Francesco
AU - Clavel, Marie Annick
AU - Vanoverschelde, Jean Louis
AU - Tribouilloy, Christophe
AU - Pizarro, Rodolfo
AU - Huebner, Marianne
AU - Avierinos, Jean Francois
AU - Barbieri, Andrea
AU - Suri, Rakesh
AU - Pasquet, Agnds
AU - Rusinaru, Dan
AU - Gargiulo, Gaetano D.
AU - Oberti, Pablo
AU - Thdron, Alexis
AU - Bursi, Francesca
AU - Michelena, Hector
AU - Lazam, Siham
AU - Szymanski, Catherine
AU - Nkomo, Vuyisile T.
AU - Schumacher, Martin
AU - Bacchi-Reggiani, Letizia
AU - Enriquez-Sarano, Maurice
N1 - Publisher Copyright:
© The Author 2017.
PY - 2018/4/14
Y1 - 2018/4/14
N2 - Aims In degenerative mitral regurgitation (DMR), lack of mortality scores predicting death favours misperception of individual patients' risk and inappropriate decision-making. Methods and results The Mitral Regurgitation International Database (MIDA) registries include 3666 patients (age 66 ± 14 years; 70% males; follow-up 7.8 ± 5.0 years) with pure, isolated, DMR consecutively diagnosed by echocardiography at tertiary (European/North/South-American) centres. The MIDA Score was derived from the MIDA-Flail-Registry (2472 patients with DMR and flail leaflet-Derivation Cohort) by weighting all guideline-provided prognostic markers, and externally validated in the MIDA-BNP-Registry (1194 patients with DMR and flail leaflet/prolapse-Validation Cohort). The MIDA Score ranged from 0 to 12 depending on accumulating risk factors. In predicting total mortality post-diagnosis, the MIDA Score showed excellent concordance both in Derivation Cohort (c = 0.78) and Validation Cohort (c = 0.81). In the whole MIDA population (n = 3666 patients), 1-year mortality with Scores 0, 7-8, and 11-12 was 0.4, 17, and 48% under medical management and 1, 7, and 14% after surgery, respectively (P < 0.001). Five-year survival with Scores 0, 7-8, and 11-12 was 98 ± 1, 57 ± 4, and 21 ± 10% under medical management and 99 ± 1, 82 ± 2, and 57 ± 9% after surgery (P < 0.001). In models including all guideline-provided prognostic markers and the EuroScoreII, the MIDA Score provided incremental prognostic information (P < 0.002). Conclusion The MIDA Score may represent an innovative tool for DMR management, being able to position a given patient within a continuous spectrum of short- and long-term mortality risk, either under medical or surgical management. This innovative prognostic indicator may provide a specific framework for future clinical trials aiming to compare new technologies for DMR treatment in homogeneous risk categories of patients.
AB - Aims In degenerative mitral regurgitation (DMR), lack of mortality scores predicting death favours misperception of individual patients' risk and inappropriate decision-making. Methods and results The Mitral Regurgitation International Database (MIDA) registries include 3666 patients (age 66 ± 14 years; 70% males; follow-up 7.8 ± 5.0 years) with pure, isolated, DMR consecutively diagnosed by echocardiography at tertiary (European/North/South-American) centres. The MIDA Score was derived from the MIDA-Flail-Registry (2472 patients with DMR and flail leaflet-Derivation Cohort) by weighting all guideline-provided prognostic markers, and externally validated in the MIDA-BNP-Registry (1194 patients with DMR and flail leaflet/prolapse-Validation Cohort). The MIDA Score ranged from 0 to 12 depending on accumulating risk factors. In predicting total mortality post-diagnosis, the MIDA Score showed excellent concordance both in Derivation Cohort (c = 0.78) and Validation Cohort (c = 0.81). In the whole MIDA population (n = 3666 patients), 1-year mortality with Scores 0, 7-8, and 11-12 was 0.4, 17, and 48% under medical management and 1, 7, and 14% after surgery, respectively (P < 0.001). Five-year survival with Scores 0, 7-8, and 11-12 was 98 ± 1, 57 ± 4, and 21 ± 10% under medical management and 99 ± 1, 82 ± 2, and 57 ± 9% after surgery (P < 0.001). In models including all guideline-provided prognostic markers and the EuroScoreII, the MIDA Score provided incremental prognostic information (P < 0.002). Conclusion The MIDA Score may represent an innovative tool for DMR management, being able to position a given patient within a continuous spectrum of short- and long-term mortality risk, either under medical or surgical management. This innovative prognostic indicator may provide a specific framework for future clinical trials aiming to compare new technologies for DMR treatment in homogeneous risk categories of patients.
KW - Mitral regurgitation
KW - Mitral repair
KW - Percutaneous mitral repair
KW - Percutaneous mitral replacement
KW - Prognosis
KW - Surgery
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U2 - 10.1093/eurheartj/ehx465
DO - 10.1093/eurheartj/ehx465
M3 - Article
C2 - 29020352
AN - SCOPUS:85041775957
SN - 0195-668X
VL - 39
SP - 1281
EP - 1291
JO - European heart journal
JF - European heart journal
IS - 15
ER -