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Artac I, Ilis D, Karakayali M, Omar T, Arslan A, Topaloğlu I, Karabag Y, Karakayon S, Rencuzogullari I. The prognostic value of the MAGGIC risk score in patients with acute pulmonary embolism. Am J Med Sci 2024:S0002-9629(24)01386-7. [PMID: 39094978 DOI: 10.1016/j.amjms.2024.07.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 07/17/2024] [Accepted: 07/17/2024] [Indexed: 08/04/2024]
Abstract
OBJECTIVES Acute pulmonary embolism (PE) is a potentially life-threatening condition characterized by the sudden blockage of the pulmonary arteries. Although the MAGGIC risk score has emerged as a valuable tool in predicting outcomes in patients with chronic heart failure, it has also been demonstrated and identified as a prognostic model in various cardiac diseases other than heart failure. In this study, we aimed to investigate the relationship between MAGGIC score and adverse outcomes in patients with PE. MATERIALS AND METHODS A total of 302 consecutive patients diagnosed with acute PE were retrospectively included in the present study. For each patient, the MAGGIC score was calculated. The study population was divided into two groups according to the median value of MAGGIC score. RESULTS Patients with high MAGGIC score had a significantly higher proportion of elderly and female individuals, lower BMI, higher presence of CAD, DM, AFib, HF, HT, CKD, COPD, and ACEI/ARB and NOAC usage. Logistic regression analyses was carried out using univariate and multivariate analysis to predict the in-hospital and 30-day mortality predictors in the included PE patients. For in-hospital mortality, diastolic blood pressure, heart rate, RV dilatation, and the MAGGIC score (HR: 1.166, 95 % CI 1.077-1.263, p < 0.001) and for short-term mortality, sPESI and the MAGGIC score (HR: 1.925, 95 % CI 1.243-2.983, p:0.003) were found to be independent predictors for adverse outcomes in patients with acute PE. CONCLUSION Our study demonstrates that the MAGGIC score can be applied as a valuable prognostic tool for acute pulmonary embolism.
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Affiliation(s)
- Inanc Artac
- Kafkas University Faculty of Medicine Department of Cardiology Kars Turkey.
| | - Dogan Ilis
- Kafkas University Faculty of Medicine Department of Cardiology Kars Turkey
| | - Muammer Karakayali
- Kafkas University Faculty of Medicine Department of Cardiology Kars Turkey
| | - Timor Omar
- Kafkas University Faculty of Medicine Department of Cardiology Kars Turkey
| | - Ayca Arslan
- Kafkas University Faculty of Medicine Department of Cardiology Kars Turkey
| | - Ihsan Topaloğlu
- Kafkas University Faculty of Medicine Department of Pulmonary Medicine Kars Turkey
| | - Yavuz Karabag
- Kafkas University Faculty of Medicine Department of Cardiology Kars Turkey
| | - Suleyman Karakayon
- Kocaeli Health and Technology University Department of Health Science Kocaeli Turkey
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de Terwangne C, Maes F, Gilard I, Kefer J, Cornette P, Boland B. OLD-TAVR score to predict 2-year mortality in patients aged 75 years and more undergoing transcatheter aortic valve replacement. Eur Geriatr Med 2023:10.1007/s41999-023-00794-x. [PMID: 37165292 DOI: 10.1007/s41999-023-00794-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2023] [Accepted: 04/26/2023] [Indexed: 05/12/2023]
Abstract
PURPOSE Decision-making on transcatheter aortic valve replacement (TAVR) in patients aged 75 years and older is complex. It could be facilitated by the identification of predictors of long-term mortality. This study aimed to identify predictors of 2-year mortality to develop a 2-year mortality risk score. METHODS Cohort study of consecutive patients aged ≥ 75 years who underwent TAVR after a comprehensive geriatric assessment (CGA) at our university hospital between 2012 and 2019. Predictors of 2-year mortality were determined using multivariable Cox regression. A point-based predictive model was developed based on risk factors and subsequently internally validated by fivefold cross-validation. RESULTS The 345 patients (median age 87 years, 54% women) were fit/vulnerable (32%), mildly frail (37%), or moderately/severely frail (31%). The overall 2-year mortality rate was 26%, predicted by atrial fibrillation, hemoglobin ≤ 10 g/dL, age ≥ 87 years, BMI ≤ 24, eGFR ≤ 50 ml/min, and moderate/severe frailty. The risk score (range 0-12), named OLD-TAVR score, for 2-year mortality showed good discriminative power (AUC 0.70) and remained consistent after fivefold cross-validation (cvAUC 0.69). A risk score ≥ 8 (prevalence 20%) predicted a 45% (95%CI: 34-58%) two-year mortality, with high specificity (86%) and good positive predictive power (+ LR 2.43). CONCLUSION A 2-year mortality risk score (OLD-TAVR score) for very old patients undergoing TAVR was developed based on six bio-clinical items. A score ≥ 8 identified patients in whom 2-year mortality was very high and thereby the TAVR futile. TRIAL REGISTRATION NUMBER AND DATE OF REGISTRATION Study protocol B403, 26/09/2022, retrospectively registered.
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Affiliation(s)
- Christophe de Terwangne
- Geriatric Medicine, Cliniques Universitaires Saint-Luc - Université Catholique de Louvain, Avenue Hippocrate 10, 1200, Brussels, Belgium.
| | - Frédéric Maes
- Division of Cardiology, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain (UCLouvain), Brussels, Belgium
- Pôle de Recherche Cardiovasculaire, Institut de Recherche Expérimentale et Clinique (IREC), Université Catholique de Louvain (UCLouvain), Brussels, Belgium
| | - Isabelle Gilard
- Geriatric Medicine, Cliniques Universitaires Saint-Luc - Université Catholique de Louvain, Avenue Hippocrate 10, 1200, Brussels, Belgium
| | - Joëlle Kefer
- Division of Cardiology, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain (UCLouvain), Brussels, Belgium
- Pôle de Recherche Cardiovasculaire, Institut de Recherche Expérimentale et Clinique (IREC), Université Catholique de Louvain (UCLouvain), Brussels, Belgium
| | - Pascale Cornette
- Geriatric Medicine, Cliniques Universitaires Saint-Luc - Université Catholique de Louvain, Avenue Hippocrate 10, 1200, Brussels, Belgium
- Institute of Health and Society (IRSS), Université Catholique de Louvain (UCLouvain), Brussels, Belgium
| | - Benoit Boland
- Geriatric Medicine, Cliniques Universitaires Saint-Luc - Université Catholique de Louvain, Avenue Hippocrate 10, 1200, Brussels, Belgium
- Institute of Health and Society (IRSS), Université Catholique de Louvain (UCLouvain), Brussels, Belgium
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Ikitimur B, Barman HA, Dogan O, Atıcı A, Meriç BK, Dogan SM, Enar R. Prognostic significance of addition of electrocardiographic findings to the MAGGIC heart failure risk score. J Electrocardiol 2022; 72:102-108. [DOI: 10.1016/j.jelectrocard.2022.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Revised: 02/17/2022] [Accepted: 03/09/2022] [Indexed: 10/18/2022]
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Sougawa H, Ino Y, Kitabata H, Tanimoto T, Takahata M, Shimamura K, Shiono Y, Yamaguchi T, Kuroi A, Ota S, Taruya A, Takemoto K, Tanaka A, Kubo T, Hozumi T, Akasaka T. Impact of left ventricular ejection fraction and preoperative hemoglobin level on perioperative adverse cardiovascular events in noncardiac surgery. Heart Vessels 2021; 36:1317-1326. [PMID: 33687544 DOI: 10.1007/s00380-021-01818-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Accepted: 02/26/2021] [Indexed: 10/22/2022]
Abstract
The prediction of a perioperative adverse cardiovascular event (PACE) is an important clinical issue in the medical management of patients undergoing noncardiac surgery. Although several predictors have been reported, simpler and more practical predictors of PACE have been needed. The aim of this study was to investigate the predictors of PACE in noncardiac surgery. We retrospectively analyzed 723 patients who were scheduled for elective noncardiac surgery and underwent preoperative examinations including 12-lead electrocardiography, transthoracic echocardiography, and blood test. PACE was defined as cardiac death, non-fatal myocardial infarction, unstable angina, congestive heart failure, arrhythmia attack that needs emergency treatment (rapid atrial fibrillation, ventricular tachycardia, and bradycardia), acute pulmonary embolism, asystole, pulseless electrical activity, or stroke during 30 days after surgery. PACE occurred in 54 (7.5%) of 723 patients. High-risk operation (11% vs. 3%, p = 0.003) was more often seen, left ventricular ejection fraction (LVEF) (55 ± 8% vs. 60 ± 7%, p = 0.001) and preoperative hemoglobin level (11.8 ± 2.2 g/dl vs. 12.7 ± 2.0 g/dl, p = 0.001) were lower in patients with PACE compared to those without PACE. By multivariate logistic regression analysis, high-risk operation (odds ratio (OR): 7.05, 95% confidence interval (CI) 2.16-23.00, p = 0.001), LVEF (OR 1.06, every 1% decrement, 95% CI 1.03-1.09, p = 0.001), and preoperative hemoglobin level (OR 1.22, every 1 g/dl decrement, 95% CI 1.07-1.39, p = 0.003) were identified as independent predictors of PACE. Receiver operating characteristic analysis demonstrated that LVEF of 58% (sensitivity = 80%, specificity = 61%, area under the curve (AUC) = 0.723) and preoperative hemoglobin level of 12.2 g/dl (sensitivity = 63%, specificity = 64%, AUC = 0.644) were optimal cut-off values for predicting PACE. High-risk operation, reduced LVEF, and reduced preoperative hemoglobin level were independently associated with PACE in patients undergoing noncardiac surgery.
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Affiliation(s)
- Hiromichi Sougawa
- Department of Cardiovascular Medicine, Wakayama Medical University, 811-1 Kimiidera, Wakayama, 641-8509, Japan
| | - Yasushi Ino
- Department of Cardiovascular Medicine, Wakayama Medical University, 811-1 Kimiidera, Wakayama, 641-8509, Japan.
| | - Hironori Kitabata
- Department of Cardiovascular Medicine, Wakayama Medical University, 811-1 Kimiidera, Wakayama, 641-8509, Japan
| | - Takashi Tanimoto
- Department of Cardiovascular Medicine, Wakayama Medical University, 811-1 Kimiidera, Wakayama, 641-8509, Japan
| | - Masahiro Takahata
- Department of Cardiovascular Medicine, Wakayama Medical University, 811-1 Kimiidera, Wakayama, 641-8509, Japan
| | - Kunihiro Shimamura
- Department of Cardiovascular Medicine, Wakayama Medical University, 811-1 Kimiidera, Wakayama, 641-8509, Japan
| | - Yasutsugu Shiono
- Department of Cardiovascular Medicine, Wakayama Medical University, 811-1 Kimiidera, Wakayama, 641-8509, Japan
| | - Tomoyuki Yamaguchi
- Department of Cardiovascular Medicine, Wakayama Medical University, 811-1 Kimiidera, Wakayama, 641-8509, Japan
| | - Akio Kuroi
- Department of Cardiovascular Medicine, Wakayama Medical University, 811-1 Kimiidera, Wakayama, 641-8509, Japan
| | - Shingo Ota
- Department of Cardiovascular Medicine, Wakayama Medical University, 811-1 Kimiidera, Wakayama, 641-8509, Japan
| | - Akira Taruya
- Department of Cardiovascular Medicine, Wakayama Medical University, 811-1 Kimiidera, Wakayama, 641-8509, Japan
| | - Kazushi Takemoto
- Department of Cardiovascular Medicine, Wakayama Medical University, 811-1 Kimiidera, Wakayama, 641-8509, Japan
| | - Atsushi Tanaka
- Department of Cardiovascular Medicine, Wakayama Medical University, 811-1 Kimiidera, Wakayama, 641-8509, Japan
| | - Takashi Kubo
- Department of Cardiovascular Medicine, Wakayama Medical University, 811-1 Kimiidera, Wakayama, 641-8509, Japan
| | - Takeshi Hozumi
- Department of Cardiovascular Medicine, Wakayama Medical University, 811-1 Kimiidera, Wakayama, 641-8509, Japan
| | - Takashi Akasaka
- Department of Cardiovascular Medicine, Wakayama Medical University, 811-1 Kimiidera, Wakayama, 641-8509, Japan
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Zhuo DX, Bilchick KC, Shah KP, Mehta NK, Mwansa H, Nkanza-Kabaso K, Kwon Y, Breathett KK, Hilton-Buchholz EJ, Mazimba S. MAGGIC, STS, and EuroSCORE II Risk Score Comparison After Aortic and Mitral Valve Surgery. J Cardiothorac Vasc Anesth 2020; 35:1806-1812. [PMID: 33349502 DOI: 10.1053/j.jvca.2020.11.053] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 11/21/2020] [Accepted: 11/23/2020] [Indexed: 11/11/2022]
Abstract
OBJECTIVES To compare the Meta-Analysis Global Group in Chronic Heart Failure (MAGGIC) risk score with the established Society of Thoracic Surgeons (STS) and EuroSCORE II risk prediction models regarding mortality discrimination after aortic and mitral valve surgery. DESIGN Retrospective cohort study. SETTING Single tertiary academic medical center. PARTICIPANTS A total of 259 patients who underwent open aortic valve replacement or open mitral valve repair/replacement from 2009-2014. INTERVENTIONS Retrospective chart review. MEASUREMENTS AND MAIN RESULTS MAGGIC, STS, and EuroSCORE II risk scores for each patient were studied using binary logistic regression and receiver operating characteristic analysis for the primary endpoint of one-year mortality and secondary endpoint of 30-day mortality. One-year mortality C-statistics were similar across risk scores (STS 0.709, 95% confidence interval [CI] 0.578-0.841; MAGGIC 0.673, 95% CI 0.547-0.799; EuroSCORE II 0.642, 95% CI 0.521-0.762; p = 0.56 between STS and MAGGIC; p = 0.20 between STS and EuroSCORE II; and p = 0.69 between MAGGIC and EuroSCORE II). Thirty-day mortality C-statistics also were similar between STS (0.797, 95% CI 0.655-0.939; p < 0.0001 v null hypothesis), MAGGIC (0.721, 95% CI 0.581-0.860; p = 0.33 v STS), and EuroSCORE II (0.688, 95% CI 0.557-0.818; p = 0.06 v STS; p = 0.68 v MAGGIC). CONCLUSIONS The MAGGIC risk score performs similarly to STS and EuroSCORE II risk models in mortality discrimination after aortic and mitral valve surgery, albeit in a small sample size. This finding has important implications in establishing MAGGIC as a viable prognostic model in this population subset, with fewer variables and ease of use representing key advantages over STS and EuroSCORE II.
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Affiliation(s)
- David X Zhuo
- University of Virginia Health System, Department of Medicine, Division of Cardiovascular Medicine, Charlottesville, VA.
| | - Kenneth C Bilchick
- University of Virginia Health System, Department of Medicine, Division of Cardiovascular Medicine, Charlottesville, VA
| | - Kajal P Shah
- University of Virginia Health System, Department of Medicine, Division of Cardiovascular Medicine, Charlottesville, VA
| | - Nishaki K Mehta
- University of Virginia Health System, Department of Medicine, Division of Cardiovascular Medicine, Charlottesville, VA
| | | | | | - Younghoon Kwon
- University of Washington Medical Center, University of Washington Division of Cardiology, Harborview Medical Center, Seattle, WA
| | - Khadijah K Breathett
- University of Arizona College of Medicine, Division of Cardiology/Sarver Heart Center, Tucson, AZ
| | | | - Sula Mazimba
- University of Virginia Health System, Department of Medicine, Division of Cardiovascular Medicine, Charlottesville, VA
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Differential prognostic accuracy of right ventricular dysfunction, the Seattle heart failure model and the MAGGIC score in patients with severe mitral regurgitation undergoing the MitraClip® procedure. IJC HEART & VASCULATURE 2020; 31:100641. [PMID: 33088899 PMCID: PMC7566949 DOI: 10.1016/j.ijcha.2020.100641] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 08/29/2020] [Accepted: 09/03/2020] [Indexed: 11/24/2022]
Abstract
Background MitraClip ® (MC) is an established procedure for severe mitral regurgitation (MR) in patients deemed unsuitable for surgery. Right ventricular dysfunction (RVD) is associated with a higher mortality risk. The prognostic accuracy of heart failure risk scores like the Seattle heart failure model (SHFM) and Meta-Analysis Global Group in Chronic Heart Failure (MAGGIC) score in pts undergoing MC with or without RVD has not been investigated so far. Methods SHFM and MAGGIC score were calculated retrospectively. RVD was determined as tricuspid annular plane systolic excursion (TAPSE) ≤15 mm. Area under receiver operating curves (AUROC) of SHFM and MAGGIC were performed for one-year all-cause mortality after MC. Results N = 103 pts with MR III° (73 ± 11 years, LVEF 37 ± 17%) underwent MC with a reduction of at least I° MR. One-year mortality was 28.2%. In Kaplan-Meier analysis, one- year mortality was significantly higher in RVD-pts (34.8% vs 2.8%, p = 0.009). Area under the Receiver Operating Characteristic (AUROC) for SHFM and MAGGIC were comparable for both scores (SHFM: 0.704, MAGGIC: 0.692). In pts without RVD, SHFM displayed a higher AUROC and therefore better diagnostic accuracy (SHFM: 0.776; MAGGIC: 0.551, p < 0.05). In pts with RVD, MAGGIC and SHFM displayed comparable AUROCs. Conclusion RVD is an important prognostic marker in pts undergoing MC. SHFM and MAGGIC displayed adequate over-all prognostic power in these pts. Accuracy differed in pts with and without RVD, indicating higher predictive power of the SHFM score in pts without RVD.
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