Prediction of Mortality and Heart Failure Hospitalization After Transcatheter Tricuspid Valve Interventions: Validation of TRISCORE.
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Adamo Marianna, Russo Giulio, Pagnesi Matteo, Pancaldi Edoardo, Alessandrini Hannes, Andreas Martin, Badano Luigi P, Braun Daniel, Connelly Kim A, Denti Paolo, Estevez-Loureiro Rodrigo, Fam Neil, Gavazzoni Mara, Hahn Rebecca T, Harr Claudia, Hausleiter Joerg, Himbert Dominique, Kalbacher Daniel, Ho Edwin, Latib Azeem, Lubos Edith, Ludwig Sebastian, Lupi Laura, Lurz Philipp, Monivas Vanessa, Nickenig Georg, Pedicino Daniela, Pedrazzini Giovanni, Pozzoli Alberto, Marafon Denise Pires, Pastorino Roberta, Praz Fabien, Rodes-Cabau Joseph, Besler Christian, Schöber Anne Rebecca, Schofer Joachim, Scotti Andrea, Piayda Kerstin, Sievert Horst, Tang Gilbert H L, Sticchi Alessandro, Messika-Zeitoun David, Thiele Holger, Schlotter Florian, von Bardeleben Ralph Stephan, Webb John, Dreyfus Julien, Windecker Stephan, Leon Martin, Maisano Francesco, Metra Marco, Taramasso Maurizio
Аннотация
OBJECTIVES: The aim of this study was to evaluate the performance of the TRI-SCORE in predicting outcomes of patients undergoing TTVI.
METHODS: TriValve (Transcatheter Tricuspid Valve Therapies) is a large multicenter multinational registry including patients undergoing TTVI. The TRI-SCORE is a risk model recently proposed to predict in-hospital mortality after tricuspid valve surgery. The TriValve population was stratified based on the TRI-SCORE tertiles. The outcomes of interest were all-cause death and all-cause death or heart failure hospitalization. Procedural complications and changes in NYHA functional class were also reported.
RESULTS: Among the 634 patients included, 223 patients (35.2%) had a TRI-SCORE between 0 and 5, 221 (34.8%) had 6 or 7, and 190 (30%) had ≥8 points. Postprocedural blood transfusion, acute kidney injury, new atrial fibrillation, and in-hospital mortality were more frequent in the highest TRI-SCORE tertile. Postprocedure length of stay increased with a TRI-SCORE increase. A TRI-SCORE ≥8 was associated with an increased risk of 30-day all-cause mortality and all-cause mortality and the composite endpoint assessed at a median follow-up of 186 days (OR: 3.00; 95% CI: 1.38-6.55; HR: 2.17; 95% CI: 1.78-4.13; HR: 2.08, 95% CI: 1.57-2.74, respectively) even after adjustment for procedural success and EuroSCORE II or Society of Thoracic Surgeons Predicted Risk of Mortality. The NYHA functional class improved across all TRI-SCORE values.
CONCLUSIONS: In the TriValve registry, the TRI-SCORE has a suboptimal performance in predicting clinical outcomes. However, a TRISCORE ≥8 is associated with an increased risk of clinical events and a lack of prognostic benefit after successful TTVI.