Background:Given their advanced age and high comorbidity, individual risk assessment is crucial in patients undergoing transcatheter mitral and tricuspid valve repair. Therefore, we evaluated the use of a comprehensive geriatric assessment score, the multidimensional prognostic index (MPI), for risk stratification in these patients.Methods:We conducted a prospective, observational single-center study, including 226 patients undergoing percutaneous repair for mitral or tricuspid regurgitation. The MPI was calculated preprocedural and covers 8 domains (activities of daily living, instrumental activities of daily living, mental status, nutrition, risk of pressure ulcers, comorbidity, medication, and marital/cohabitation status). We sought to identify an association of MPI score with procedural outcomes and 6-month mortality.Results:A total of 53.1% of patients were stratified as low risk according to MPI (MPI-1 group), 44.2% as medium risk (MPI-2 group), and 2.7% as high risk (MPI-3 group). Procedural efficacy and safety were similar between groups. The estimated survival rate at 6 months was 97±2% in MPI-1 group, 79±4% in MPI-2 group (hazard ratio, 6.90 [95% CI, 2.36–12.2]; P≤0.001) and 50±20% in MPI-3 group (hazard ratio, 20.3 [95% CI, 4.51–91.3]; P<0.001). An increase in 1 SD of the MPI score (0.14 points, possible range of MPI score 0–1) was associated with a hazard ratio of 2.13 (95% CI, 1.58–2.73; P≤0.001) for death after 6 months. The risk association of the MPI with mortality remained significant in multivariate analysis including risk factors, such as peripheral artery disease and NT-proBNP (N-terminal pro-B-type natriuretic peptide) levels.Conclusions:A comprehensive geriatric assessment with the MPI score provides additional information on mortality risk beyond established cardiovascular risk factors.

中文翻译：

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使用多维老年评估对接受二尖瓣和三尖瓣经皮修复的患者进行风险分层

背景：鉴于他们的高龄和高合并症，个体风险评估对于接受经导管二尖瓣和三尖瓣修复术的患者至关重要。因此，我们评估了综合老年评估评分、多维预后指数 (MPI) 对这些患者的风险分层的使用。方法：我们进行了一项前瞻性、观察性单中心研究，包括 226 名接受二尖瓣或二尖瓣经皮修复的患者。三尖瓣反流。MPI 是在术前计算的，涵盖 8 个领域（日常生活活动、日常生活的工具性活动、精神状态、营养、压疮风险、合并症、药物治疗和婚姻/同居状态）。我们试图确定 MPI 评分与手术结果和 6 个月死亡率之间的关联。结果：共 53 个。根据 MPI（MPI-1 组），1% 的患者被分层为低风险，44.2% 为中等风险（MPI-2 组），2.7% 为高风险（MPI-3 组）。各组之间的程序有效性和安全性相似。MPI-1 组 6 个月的估计生存率为 97±2%，MPI-2 组为 79±4%（风险比，6.90 [95% CI，2.36-12.2]；P ≤0.001）和 MPI-3 组的 50±20%（风险比，20.3 [95% CI，4.51-91.3]；P <0.001）。MPI 评分增加 1 SD（0.14 分，MPI 评分的可能范围为 0-1）与 6 个月后死亡的风险比为 2.13（95% CI，1.58-2.73；P ≤0.001）相关。MPI 与死亡率的风险关联在多变量分析中仍然显着，包括风险因素，例如外周动脉疾病和 NT-proBNP（N 末端前 B 型利钠肽）水平。结论：使用 MPI 评分进行的综合老年评估提供了超出既定心血管风险因素的死亡风险的更多信息。