Skip to main content
SpringerLink
Log in

The MAGGIC risk score predicts mortality in patients undergoing transcatheter aortic valve replacement: sub-analysis of the OCEAN-TAVI registry

  • Original Article
  • Published:
Heart and Vessels Aims and scope Submit manuscript

Abstract

This study is aimed to evaluate the performance of MAGGIC risk score for predicting mortality by external validation using multicenter transcatheter aortic valve replacement (TAVR) registry. We assessed 1383 patients who underwent TAVR from October 2013 to April 2016. Patients were divided into 2 groups according to the median of MAGGIC score and we compared the incidence of all-cause death between high and low MAGGIC score. To assess whether the MAGGIC risk score add prognostic value on STS risk score, we also compared the incidence of all-cause death between the 2 groups according to low, intermediate, and high STS score. The median of MAGGIC score was 29 (interquartile range: 13–46). Within 2 years, 147 cases of all-cause death were observed. The high MAGGIC (30–46) risk score was significantly associated with an increased risk of all-cause death as compared to low MAGGIC (11–29) risk score and this relationship was also observed in patients with high STS risk score. However, this relationship was not observed in patients with low and intermediate STS score. Multivariate analysis showed that the MAGGIC risk score was an independent predictor of all-cause death (hazard ratio, 1.07; 95% confidence interval, 1.03–1.11). Our results demonstrated that the MAGGIC score predicts all-cause death in TAVR population and provides better risk stratification, particularly in patients with high STS risk.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Mylotte D, Osnabrugge RL, Windecker S, Lefèvre T, de Jaegre P, Jeger R, Wenaweser P, Maisano F, Moat N, Søndergaard L, Bosmans J, Teles RC, Martucci G, Manoharan G, Garcia E, Van Mieghem NM, Kappetein AP, Serruys PW, Lange R, Piazza N (2013) Transcatheter aortic valve replacement in Europe: adoption trends and factors influencing device utilization. J Am Coll Cardiol 62:210–219

    Article  Google Scholar 

  2. Gilard M, Eltchaninoff H, Iung B, Donzeau-Gouge P, Chevreul K, Fajadet J, Leprince P, Leguerrier A, Lievre M, Prat A, Teiger E, Lefèvre T, Tchetche D, Carrié D, Albat B, Cribier A, Rioufol G, Sudre A, Blanchard D, Collet F, Dos Snatos P, Meneveau N, Tirouvanziam A, Caussin C, Guyon P, Boschat J, Le Breton H, Collart F, Houel R, Delpine S, Souteyrand G, Favereau X, Ohlmann P, Doisy V, Grollier G, Gommeaux A, Claudel JP, Bourlon F, Bertrand B, Van Belle E, Laskar M, FRANCE 2 Investigators (2012) Registry of transcatheter aortic-valve implantation in high-risk patients. N Engl J Med 366:1705–1715

    Article  CAS  Google Scholar 

  3. Thourani VH, Kodali S, Makkar RR, Herrmann HC, Williams M, Babaliaros V, Smalling R, Lim S, Malaisrie SC, Kapadia S, Szeto WY, Greason KL, Kereiakes D, Ailawadi G, Whisenant BK, Devireddy C, Leipsic J, Hahn RT, Pibarot P, Weissman NJ, Jaber WA, Cohen DJ, Suri R, Tuzcu EM, Svensson LG, Webb JG, Moses JW, Mack MJ, Miller DC, Smith CR, Alu MC, Parvataneni R, D’Agostino RB Jr, Leon MB (2016) Transcatheter aortic valve replacement versus surgical valve replacement in intermediate-risk patients: a propensity score analysis. Lancet 387:2218–2225

    Article  Google Scholar 

  4. Edwards FH, Cohen DJ, O’Brien SM, Peterson ED, Mack MJ, Shahian DM, Grover FL, Tuzcu EM, Thourani VH, Carroll J, Brennan JM, Brindis RG, Rumsfeld J, Holmes DR, Steering Committee of the Society of Thoracic Surgeons/American College of Cardiology Transcatheter Valve Therapy Registry (2016) Development and validation of a risk prediction model for in-hospital mortality after transcatheter aortic valve replacement. JAMA Cardiol 1:46–52

    Article  Google Scholar 

  5. Arsalan M, Maren W, Hecker F, Filardo G, Kim WK, Pollock BD, Van Linden A, Arsalan-Werner A, Renker M, Doss M, Kalbas S, Hamm CW, Liebetrau C, Mack MJ, Walther T (2018) TAVI risk scoring using established versus new scoring systems: role of the new STS/ACC model. EuroIntervention 13:1520–1526

    Article  Google Scholar 

  6. Shirai S, Taniguchi T, Morimoto T, Ando K, Korai K, Minakata K, Hanyu M, Yamazaki F, Koyama T, Komiya T, Kanamori N, Murata K, Kitai T, Kawase Y, Izumi C, Inada T, Minamino-Muta E, Kato T, Inoko M, Ishii K, Saito N, Yamanaka K, Nishiwaki N, Nakajima H, Saga T, Nakayama S, Sakaguchi G, Iwakura A, Shiraga K, Ueyama K, Fujiwara K, Miwa S, Nishizawa J, Kitano M, Kitayama H, Sakata R, Kimura T, Registry Investigators CURRENTAS (2017) Five-year clinical outcome of asymptomatic vs. symptomatic severe aortic stenosis after aortic valve replacement. Circ J 81:485–494

    Article  Google Scholar 

  7. Pocock SJ, Ariti CA, McMurray JJ, Maggioni A, Køber L, Squire IB, Swedberg K, Dobson J, Poppe KK, Whalley GA, Doughty RN, Meta-Analysis Global Group in Chronic Heart Failure (2013) Predicting survival in heart failure: a risk score based on 39372 from 30 studies. Eur Heart J 34:1404–1413

    Article  Google Scholar 

  8. Sartipy U, Dahlström U, Edner M, Lund LH (2014) Predicting survival in heart failure: validation of the MAGGIC heart failure risk score in 51043 patients from the Swedish Heart Failure Registry. Eur J Heart Fail 16:173–179

    Article  Google Scholar 

  9. Kappetein AP, Head SJ, Généreux P, Piazza N, van Mieghem NM, Blackstone EH, Brott TG, Cohen DJ, Cutlip DE, van Es GA, Hahn RT, Kirtane AJ, Krucoff MW, Kodali S, Mack MJ, Mehran R, Rodés-Cabau J, Vranckx P, Webb JG, Windecker S, Serruys PW, Leon MB (2012) Updated standardized endpoint definitions for transcatheter aortic valve implantation: the Valve Academic Research Consortium-2 consensus document. Eur Heart J 33:2403–2418

    Article  Google Scholar 

  10. Hermmann K, Sirotina M, De Rosa S, Ehrlich JR, Fox H, Weber J, Moritz A, Zeiher AM, Hofmann I, Schächinger V, Doss M, Sievert H, FichtlschererS Lehmann R (2013) The STS score is the strongest predictor of long-term survival following transcatheter aortic valve implantation, whereas access route (transapical versus transfemoral) has no predictive value beyond the periprocedural phase. Interact Cardiovasc Thorac Surg 17:359–364

    Article  Google Scholar 

  11. Canepa M, Fonseca C, Chioncel O, Laroche C, Crespo-Leiro MG, Coats AJS, Mebazaa A, Piepoli MF, Tavazzi L, Maggioni AP, Long Term Registry Investigators ESC (2018) Performance of prognostic risk scores in chronic heart failure patients enrolled in the European Society of cardiology heart failure long-term registry. JACC Heart Fail 6:452–462

    Article  Google Scholar 

  12. Moat NE, Ludman P, de Belder MA, Bridgewater B, Cunningham AD, Young CP, Thomas M, Kovac J, Spyt T, MacCarthy PA, Wendler O, Hildick-Smith D, Davies SW, Trivedi U, Blackman DJ, Levy RD, Brecker SJ, Baumbach A, Daniel T, Gray H, Mullen MJ (2011) Long-term outcomes after transcatheter aortic valve implantation in high-risk patients with severe aortic valve stenosis: the UK TAVI (United Kingdom Transcatheter Aortic Valve Implantation) Registry. J Am Coll Cardiol 58:2130–2138

    Article  Google Scholar 

  13. Gilard M, Eltchaninoff H, Iung B, Donzeau-Gouge P, Chevreul K, Fajadet J, Leguerrier A, Lievre M, Prat A, Teiger E, Lefevre T, Himbert D, Tchetche D, Carrié D, Albat B, Cribier A, Rioufol G, Sudre A, Blanchard D, Collet F, Dos Santos P, Meneveau N, Tirouvanziam A, Caussin C, Guyon P, Boschat J, Le Breton H, Collart F, Houel R, Delpine S, Souteyrand G, Favereau X, Ohlmann P, Doisy V, Grollier G, Gommeaux A, Claudel JP, Bourlon F, Bertrand B, Van Belle E, Lasker M, FRANCE 2 Investigators (2012) Registry of transcatheter aortic valve implantation in high-risk patients. N Engl J Med 366:1705–1715

    Article  CAS  Google Scholar 

  14. Hamm CW, Möllmann H, Holzhey D, Beckmann A, Veit C, Figulla HR, Cremer J, Kuck KH, Lange R, Zahn R, Sack S, Schuler G, Walther T, Beyersdorf F, Böhm M, Heusch G, Funkat AK, Meinertz T, Neumann T, Papoutsis K, Schneider S, Welz A, Mohr FW, GARY-Executive Board (2014) The German aortic valve registry (GARY): in-hospital outcome. Eur Heart J 35:1588–1598

    Article  Google Scholar 

  15. Allende R, Webb JG, Munoz-Garcia AJ, de Jaegere P, Tamburino C, Dager AE, Cheema A, Serra V, Amat-Santos I, Velianou JL, Barbanti M, Dvir D, Alonso-Briales JH, Nuis RJ, Faqiri E, Imme S, Benitez LM, Cucalon AM, Al Lawati H, Garcia del Blanco B, Lopez J, Natarajan MK, DeLarochellière R, Urena M, Ribeiro HB, Dumont E, Nombela-Franco L, Rodés-Cabau J (2014) Advanced chronic kidney disease in patients undergoing transcatheter aortic valve implantation: insights on clinical outcomes and prognostic marker from a large cohort of patients. Eur Heart J 35:2685–2696

    Article  Google Scholar 

  16. Sannino A, Gargiulo G, Schiattarella GG, Brevetti L, Perriono C, Stabile E, Losi MA, Toscano E, Giugliano G, Scudiero F, Chiacchio E, Trimarco B, Esposito G (2014) Increased mortality after transcatheter aortic valve implantation (TAVI) in patients with severe aortic stenosis and low ejection fraction: a meta-analysis of 6898 patients. Int J Cardiol 176:32–39

    Article  Google Scholar 

  17. Yamamoto M, Mouillet G, Oguri A, Gilard M, Laskar M, Eltchaninoff H, Fajadet J, Iung B, Donzeau-Gouge P, Leprince P, Leuguerrier A, Prat A, Lievre M, Chevreul K, Dubois-Rande JL, Teiger E, FRANCE 2 Registry Investigators (2013) Effect of body mass index on 30- and 365-day complication and survival rates after transcatheter aortic valve implantation (from the FRench Aortic National CoreValve and Edwards 2 [FRANCE 2] registry). Am J Cardiol 112:1932–1937

    Article  Google Scholar 

  18. Conrotto F, D’Ascenzo F, Presbitero P, Humphries KH, Webb JG, O’Connor SA, Morice MC, Lefèvre T, Grasso C, Sbarra P, Taha S, Omedè P, Crosso Marra W, Salizzoni S, Moretti C, D’Amico M, Biondi-Zoccai G, Gaita F, Marra S (2015) Effect of gender after transcatheter aortic valve implantation: a meta-analysis. Ann Thorac Surg 99:809–816

    Article  Google Scholar 

  19. Mok M, Nombela-Franco L, Dumont E, Urena M, DeLarochellière R, Doyle D, Villeneuve J, Côte M, Ribeiro HB, Allende R, Laflamme J, DeLarochellière H, Laflamme L, Amat-Santos I, Pibarot P, Maltais F, Rodès-Cabau J (2013) Chronic obstructive pulmonary disease in patients undergoing transcatheter aortic valve implantation: insights on clinical outcomes, prognostic markers, and functional status changes. JACC Cardiovasc Interv 6:1072–1084

    Article  Google Scholar 

  20. Abramowitz Y, Jilaihawi H, Chakravarty T, Mangat G, Maeno Y, Kazuno Y, Takahashi N, Kawamori H, Cheng W, Makkar RR (2016) Impact of diabetes mellitus on outcomes after transcatheter aortic valve implantation. Am J Cardiol 117:1636–1642

    Article  Google Scholar 

  21. Dalos D, Mascherbauer J, Zotter-Tufaro C, Duca F, Kammerkander AA, Aschauer S, Bonderman D (2016) Functional status, pulmonary artery pressure, and clinical outcomes in heart failure with preserved ejection fraction. J Am Coll Cardiol 68:189–199

    Article  Google Scholar 

  22. Nadir MA, Wei L, Elder DH, Libianto R, Lim TK, Pauriah M, Pringle SD, Doney AD, Choy AM, Struthers AD, Lang CC (2011) Impact of renin-angiotensin system blockade on outcome in aortic stenosis. J Am Coll Cardiol 58:570–576

    Article  CAS  Google Scholar 

  23. Rossi A, Temporelli PL, Cicoira M, Gaibazzi N, Cioffi G, Nistri S, Magatelli M, Tavazzi L, Faggiano P (2015) Beta-blockers can improve survival in medically-treated patients with severe symptomatic aortic stenosis. Int J Cardiol 190:15–17

    Article  Google Scholar 

  24. Böhm M, Komajda M, Borer JS, Ford I, Maack C, Tavazzi L, Moyne A, Swedberg K, Investigators SHIFT (2018) Duration of chronic heart failure affects outcomes with preserved effects on heart rate reduction with ivabradine; the findings from SHIFT. Eur J Heart Fail 20:373–381

    Article  Google Scholar 

  25. Koene RJ, Prizment AE, Blaes A, Konety SH (2016) Shared risk factors in cardiovascular disease and cancer. Circulation 133:1104–1114

    Article  Google Scholar 

  26. Benfield T, Lange P, Vestbo J (2008) COPD stage and risk of hospitalization for infectious disease. Chest 134:46–53

    Article  Google Scholar 

  27. Wang HE, Gamboa C, Warnock DG, Muntner P (2011) Chronic kidney disease and risk of death from infection. Am J Nephrol 34:330–336

    Article  Google Scholar 

  28. Bertoni AG, Saydah S, Brancati FL (2001) Diabetes and the risk of infection-related mortality in the U.S. Diabetes Care 24:1044–1049

    Article  CAS  Google Scholar 

Download references

Acknowledgements

The authors thank the investigators and institutions that have participated in the OCEAN-TAVI registry.

Funding

Dr. Y. Watanabe, M. Yamamoto, T. Naganuma, M. Araki, N. Tada, S. Shirai, K. Takagi, and K. Hayashida are proctor for transfemoral-TAVI for Edwards Lifesciences. Dr. Y. Watanabe, M. Yamamoto, and T. Naganuma are proctor for transfemoral-TAVI for Medtronic. Dr. M. Tabata is a proctor for transapical-TAVI for Edwards Lifesciences. The other authors report nothing to disclose in this study.

Author information

Authors and Affiliations

  1. Division of Cardiology, Department of Internal Medicine, Teikyo University Hospital, 2-11-1 Kaga, Itabashi-ku, Tokyo, 173-0003, Japan

    Hirofumi Hioki, Yusuke Watanabe, Ken Kozuma, Hideyuki Kawashima, Fukuko Nagura, Makoto Nakashima & Akihisa Kataoka

  2. Toyohashi Heart Center, Aichi, Japan

    Masanori Yamamoto

  3. New Tokyo Hospital, Chiba, Japan

    Toru Naganuma

  4. Saiseikai Yokohama City Eastern Hospital, Yokohama, Japan

    Motoharu Araki

  5. Sendai Kosei Hospital, Sendai, Japan

    Norio Tada

  6. Kokura Memorial Hospital, Fukuoka, Japan

    Shinichi Shirai

  7. Shonan Kamakura General Hospital, Kanmakura, Japan

    Futoshi Yamanaka

  8. Kishiwada Tokushukai Hospital, Kishiwada, Japan

    Akihiro Higashimori

  9. Osaka City University Graduate School of Medicine, Osaka, Japan

    Kazuki Mizutani

  10. Tokyo Bay Urayasu Ichikawa Medical Center, Urayasu, Japan

    Minoru Tabata

  11. Ogaki Municipal Hospital, Ogaki, Japan

    Kensuke Takagi

  12. University of Toyama, Toyama, Japan

    Hiroshi Ueno

  13. Keio University School of Medicine, Tokyo, Japan

    Kentaro Hayashida

Authors
  1. Hirofumi Hioki
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Yusuke Watanabe
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Ken Kozuma
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Hideyuki Kawashima
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Fukuko Nagura
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Makoto Nakashima
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Akihisa Kataoka
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Masanori Yamamoto
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Toru Naganuma
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Motoharu Araki
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Norio Tada
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Shinichi Shirai
    View author publications

    You can also search for this author in PubMed Google Scholar

  13. Futoshi Yamanaka
    View author publications

    You can also search for this author in PubMed Google Scholar

  14. Akihiro Higashimori
    View author publications

    You can also search for this author in PubMed Google Scholar

  15. Kazuki Mizutani
    View author publications

    You can also search for this author in PubMed Google Scholar

  16. Minoru Tabata
    View author publications

    You can also search for this author in PubMed Google Scholar

  17. Kensuke Takagi
    View author publications

    You can also search for this author in PubMed Google Scholar

  18. Hiroshi Ueno
    View author publications

    You can also search for this author in PubMed Google Scholar

  19. Kentaro Hayashida
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Hirofumi Hioki.

Ethics declarations

Conflict of interest

The authors report no relationships that could be construed as conflict of interest.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary material 1 (DOCX 18 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Hioki, H., Watanabe, Y., Kozuma, K. et al. The MAGGIC risk score predicts mortality in patients undergoing transcatheter aortic valve replacement: sub-analysis of the OCEAN-TAVI registry. Heart Vessels 34, 1976–1983 (2019). https://doi.org/10.1007/s00380-019-01443-9

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00380-019-01443-9

Keywords

Search

Navigation