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

Background: 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. Method: 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). Results: 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). Conclusion: 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.