Immediate and long-term predictor score of success after percutaneous mitral balloon commissurotomy

BACKGROUND: Percutaneous mitral balloon commissurotomy (PMBC) remains the preferred treatment for patients with severe symptomatic rheumatic mitral stenosis (MS) and suitable anatomy. The objective of this study was to propose a new score for the prediction of immediate and late success. METHODS. This is a retrospective, single-center, single-arm registry encompassing all 1915 consecutive patients with rheumatic mitral stenosis recruited and referred to PMBC between August 3rd 1987 and July 19th 2010. All data were previously collected and recorded in a dataset. Clinical status was determined according to the New York Heart Association (NYHA) classification. Long-term outcome was a composite of incidence of major adverse cardiac events (cardiovascular death, new PMBC or mitral valve repair surgery) up to 24 years of clinical follow-up (from 1988 until December 3rd, 2011), including cardiovascular death, need for new PMBC, or mitral valve replacement surgery. RESULTS. Mean patient age was 36.8 ± 12.9 years, most (86.4%) were female, and Wilkins score was between 9-11 in 49.1% of patients. In the multivariate analysis, the predictors of immediate success were age (odds ratio [OR], 0.98; 95% confidence interval [CI], 0.96-0.99; p=0.01), left atrium size (OR, 0.96; 95% CI, 0.93-0.99; p=0.01), mean pre-procedure mitral gradient (OR, 0.93; 95% CI, 0.89-0.96; p<0.001), intermediate Wilkins score 9-11 (OR, 0.62; 95% CI, 0.40- 0.94; p=0.02), and high Wilkins score ≥12 (OR, 0.35; 95% CI, 0.16-0.76; p<0.01). For prediction of late events, age (hazard ratio [HR], 0.98; 95% CI, 0.97-0.98; p<0.001), New York Heart Association class III-IV (HR, 1.50; 95% CI, 1.18-1.92; p<0.001), left atrium size (HR, 1.02; 95% CI, 1.02-0.04; p<0.01), and high Wilkins score ≥12 (HR, 2.02; 95% CI, 1.30-3.15; p<0.01) were significant. Two nomograms were developed using significant predictors from the model (one for immediate results and another for long-term results). CONCLUSIONS: In this large population, not only the Wilkins score, but also clinical and hemodynamic features, seem to be relevant in predicting immediate and late success for patients with rheumatic MS who underwent PMBC.

Novel prognostic score for immediate and late success after percutaneous mitral balloon commissurotomy in patients with mitral stenosis

INTRODUCTION: Percutaneous mitral balloon commissurotomy (PMBC) remains the preferred treatment for patients with severe symptomatic rheumatic mitral stenosis (MS) and suitable anatomy. OBJECTIVE: The objective of this study was to propose a new score for the prediction of immediate and late success. METHODS: This is a retrospective, single-center, single-arm registry encompassing all 1915 consecutive patients with rheumatic mitral stenosis recruited and referred to PMBC between August 3rd 1987 and July 19th 2010. All data were previously collected and recorded in a dataset. Clinical status was determined according to the New York Heart Association (NYHA) classification. Long-term outcome was a composite of incidence of major adverse cardiac events (cardiovascular death, new PMBC or mitral valve repair surgery) up to 24 years of clinical follow-up (from 1988 until December 3rd, 2011), including cardiovascular death, need for new PMBC, or mitral valve replacement surgery. RESULTS: Mean patient age was 36.8 ± 12.9 years, most (86.4%) were female, and Wilkins score was between 9-11 in 49.1% of patients. In the multivariate analysis, the predictors of immediate success were age (odds ratio [OR], 0.98; 95% confidence interval [CI], 0.96-0.99; p = 0.01), left atrium size (OR, 0.96; 95% CI, 0.93-0.99; p = 0.01), mean pre-procedure mitral gradient (OR, 0.93; 95% CI, 0.89-0.96; p < 0.001), intermediate Wilkins score 9-11 (OR, 0.62; 95% CI, 0.40-0.94; p = 0.02), and high Wilkins score ≥12 (OR, 0.35; 95% CI, 0.16-0.76; p < 0.01). For prediction of late events, age (hazard ratio [HR], 0.98; 95% CI, 0.97-0.98; p < 0.001), New York Heart Association class III-IV (HR, 1.50; 95% CI, 1.18-1.92; p < 0.001), left atrium size (HR, 1.02; 95% CI, 1.02-0.04; p < 0.01), and high Wilkins score ≥12 (HR, 2.02; 95% CI, 1.30-3.15; p < 0.01) were significant. Two nomograms were developed using significant predictors from the model (one for immediate results and another for long-term results). CONCLUSIONS: In this large population, not only the Wilkins score, but also clinical and hemodynamic features, seem to be relevant in predicting immediate and late success for patients with rheumatic MS who underwent PMBC.

Novel prognostic score for immediate and late success after percutaneous mitral balloon commissurotomy in patients with mitral stenosis

Abstract: Objectives. Percutaneous mitral balloon commissurotomy (PMBC) remains the preferred treatment for patients with severe symptomatic rheumatic mitral stenosis (MS) and suitable anatomy. The objective of this study was to propose a new score for the prediction of immediate and late success. Methods. This is a single-center, retrospective analysis of all 1582 patients with severe mitral stenosis who underwent PMBC from August 1987 to July 2010. The composite outcome was cardiovascular death, new PMBC, or mitral valve repair surgery up to 24 years of follow-up. Results. Mean patient age was 36.8 ± 12.9 years, most (86.4%) were female, and Wilkins score was between 9-11 in 49.1% of patients. In the multivariate analysis, the predictors of immediate success were age (odds ratio [OR], 0.98; 95% confidence interval [CI], 0.96-0.99; P=.01), left atrium size (OR, 0.96; 95% CI, 0.93-0.99; P=.01), mean preprocedure mitral gradient (OR, 0.93; 95% CI, 0.89-0.96; P<.001), intermediate Wilkins score 9-11 (OR, 0.62; 95% CI, 0.40-0.94; P=.02), and high Wilkins score ≥12 (OR, 0.35; 95% CI, 0.16-0.76; P<.01). For prediction of late events, age (hazard ratio [HR], 0.98; 95% CI, 0.97-0.98; P<.001), New York Heart Association class III-IV (HR, 1.50; 95% CI, 1.18-1.92; P<.001), left atrium size (HR, 1.02; 95% CI, 1.02-0.04; P<.01), and high Wilkins score ≥12 (HR, 2.02; 95% CI, 1.30-3.15; P<.01) were significant. Two nomograms were developed using significant predictors from the model. Conclusions. In this large population, not only the Wilkins score, but also clinical and hemodynamic features, seem to be relevant in predicting immediate and late success for patients with rheumatic MS who underwent PMBC.

Novel Prognostic Score for Immediate and Late Success After Percutaneous Mitral Balloon Commissurotomy in Patients With Mitral Stenosis.

OBJECTIVES: Percutaneous mitral balloon commissurotomy (PMBC) remains the preferred treatment for patients with severe symptomatic rheumatic mitral stenosis (MS) and suitable anatomy. The objective of this study was to propose a new score for the prediction of immediate and late success. METHODS: This is a single-center, retrospective analysis of all 1582 patients with severe mitral stenosis who underwent PMBC from August 1987 to July 2010. The composite outcome was cardiovascular death, new PMBC, or mitral valve repair surgery up to 24 years of follow-up. RESULTS: Mean patient age was 36.8 ± 12.9 years, most (86.4%) were female, and Wilkins score was between 9-11 in 49.1% of patients. In the multivariate analysis, the predictors of immediate success were age (odds ratio [OR], 0.98; 95% confidence interval [CI], 0.96-0.99; P=.01), left atrium size (OR, 0.96; 95% CI, 0.93-0.99; P=.01), mean preprocedure mitral gradient (OR, 0.93; 95% CI, 0.89-0.96; P<.001), intermediate Wilkins score 9-11 (OR, 0.62; 95% CI, 0.40-0.94; P=.02), and high Wilkins score ≥12 (OR, 0.35; 95% CI, 0.16-0.76; P<.01). For prediction of late events, age (hazard ratio [HR], 0.98; 95% CI, 0.97-0.98; P<.001), New York Heart Association class III-IV (HR, 1.50; 95% CI, 1.18-1.92; P<.001), left atrium size (HR, 1.02; 95% CI, 1.02-0.04; P<.01), and high Wilkins score ≥12 (HR, 2.02; 95% CI, 1.30-3.15; P<.01) were significant. Two nomograms were developed using significant predictors from the model. CONCLUSIONS: In this large population, not only the Wilkins score, but also clinical and hemodynamic features, seem to be relevant in predicting immediate and late success for patients with rheumatic MS who underwent PMBC.

Novo escore prognóstico preditor de sucesso imediato e tardio após valvuloplastia mitral percutânea / New predictive prognostic score for immediate and late success after percutaneous mitral valvuloplasty

INTRODUÇÃO: A valvuloplastia mitral percutânea por balão (VMP) continua sendo o tratamento preferencial para pacientes com estenose mitral (EM) reumática sintomática grave e com anatomia adequada. O objetivo deste estudo foi propor uma nova pontuação para predizer sucesso imediato e tardio. MÉTODOS: Trata-se de uma análise retrospectiva unicêntrica de todos os 1582 pacientes com estenose mitral grave submetidos à VMP de agosto de 1987 a julho de 2010 com valva nativa. O desfecho composto foi morte de origem cardiovascular, nova VMP ou cirurgia de reparo mitral até 24 anos de seguimento. RESULTADOS: A média de idade foi 36,8 ± 12,9 anos, a maioria do sexo feminino (86,4%), e o escore de Wilkins foi entre 9 e 11 (49,1%). Na análise multivariada, os preditores de sucesso imediato foram idade [OR (razão dos riscos): 0,98, IC (intervalo de confiança) 95%: 0,96-0,99, p = 0,01], tamanho do átrio esquerdo (OR: 0,96, IC95%: 0,93-0,99, p = 0,01) , gradiente mitral médio pré-procedimento do (OR: 0,93, IC95%: 0,89-0,96, p = 0,0001), Wilkins-score 9-11 (OR: 0,62, IC 95%: 0,40-0,94, p = 0,02) e Wilkins-score pontuação ≥ 12 (OR: 0,35, IC 95%: 0,16-0,76, p = 0,008). Para predição de eventos tardios, idade [RR (risco relativo): 0,98, IC 95%: 0,97-0,98, p = 0,0001], NYHA III-IV (RR: 1,50, IC 95%: 1,18-1,92, p = 0,0009), tamanho do átrio esquerdo (RR: 1,02; IC95%: 1,02-0,04; p = 0,003); Wilkins-score 9-11 (RR: 1,10; IC95%: 0,87-1,38; p = 0,40) e Wilkins-score ≥ 12 (RR: 2,02, IC 95%: 1,30-3,15, p = 0,001) foram significativos. Dois nomogramas foram desenvolvidos usando preditores significativos do modelo. Nós avaliamos a precisão preditiva do nomograma usando a curva ROC AUC e o nomograma foi calibrado. CONCLUSÕES: Nesta grande população, não apenas o escore estabelecido de Wilkins, mas também as características clínicas e hemodinâmicas, parecem ser relevantes na predição de sucesso imediato e tardio em pacientes com EM reumática submetidos à VMP. CONCLUSÕES: Nesta grande população, não apenas o escore estabelecido de Wilkins, mas também as características clínicas e hemodinâmicas, parecem ser relevantes na predição de sucesso imediato e tardio em pacientes com EM reumática submetidos à VMP. (AU)