Prognostic impact of a novel risk score for transcatheter edge-to-edge repair in patients with heart failure: sub-analysis of FRAGILE-HF

Abstract Background MitraScore is a novel, simple, and manually calculatable risk score developed as a prognostic model for patients undergoing transcatheter edge-to-edge repair (TEER) for mitral regurgitation. As its components are considered prognostic in heart failure (HF), we aimed to investigate the usefulness of the MitraScore in HF patients. Methods We calculated MitraScore for 1100 elderly patients (>65 years old) hospitalized for HF in the prospective multicenter FRAGILE-HF study and compared its prognostic ability with other simple risk scores. The primary endpoint was all-cause deaths, and the secondary endpoints were the composite of all-cause deaths and HF rehospitalization and cardiovascular deaths. Results During a follow-up of two years, 226 all-cause deaths, 478 composite endpoints, and 183 cardiovascular deaths were observed. MitraScore successfully stratified patients for all endpoints in Kaplan-Meier analysis (p<0.001 for all). In multivariate analyses, MitraScore was significantly associated with all endpoints after covariate adjustments (adjusted hazard ratio (HR) [95% confidence interval]: 1.22 [1.10-1.36], p<0.001 for all-cause deaths; adjusted HR 1.17 [1.09-1.26], p<0.001 for combined endpoints; and adjusted HR 1.24 [1.10-1.39], p<0.001 for cardiovascular deaths). Hosmer-Lemeshow plot showed good calibration for all endpoints (p = 0.86-0.99). MitraScore resulted in significant reclassification improvements in all-cause and cardiovascular deaths as compared with the GWTG-HF risk score, BIOSTAT compact model, AHEAD and AHEAD-U scores, and HANBAH score. Conclusion MitraScore developed for patients undergoing TEER also showed strong discriminative power in HF patients. These results might suggest that HF patients and those receiving TEER shared similar prognostic factors.Kaplan–Meier curves for all-cause deathComparison with other scores