Predictive Value of Age-Adjusted Charlson Co-Morbidity Index for 1-, 3-, and 5-Year Mortality in Patients Requiring Transcatheter Mitral Valve Repair

Co-morbidities increase markedly with aging, and they often negatively affect its prognosis. Although mortality with transcatheter mitral valve repair (TMVr) is significantly less than for open mitral valve surgery in patients at high surgical risk, it remains a concern to identify which patients will benefit from this treatment. Some prognostic metrics have been reported to guide better patient selection; however, universal risk stratification measures have not been established. This study aimed to determine if age-adjusted Charlson co-morbidity index (CCI) could predict mortality in patients who underwent TMVr and to assess its discriminatory performance in long-term outcomes. We retrospectively reviewed 222 patients who underwent TMVr, and 7 who died in hospital was excluded. Cox proportional hazard models were applied to select the demographic characteristics that were associated with cumulative mortality. Receiver-operating characteristic analyses were performed for predicting all-cause mortality, and discriminatory performance was assessed. We found that the age-adjusted CCI (hazard ratio 1.33, 95% confidence interval 1.16 to 1.51, p <0.001), New York Heart Association classification, and atrial fibrillation were independently associated with mortality. The age-adjusted CCI demonstrated good discriminative performance for predicting mortality at 3 and 5 years (area under the curve 0.71 and 0.77, respectively) and were greater than those of the Society of Thoracic Surgeons score in receiver-operating characteristic analysis. Kaplan-Meier curve demonstrated that the age-adjusted CCI ≥ 8 had poor prognosis after TMVr. In conclusions, the age-adjusted CCI could predict mortality and had a good discriminative performance for predicting longer term outcomes in patients who underwent TMVr.