Author + information
- Received September 13, 2018
- Revision received November 27, 2018
- Accepted December 12, 2018
- Published online March 18, 2019.
- Sameer Arora, MDa,b,
- Sreekanth Vemulapalli, MDc,d,
- Amanda Stebbins, MSd,
- Cassandra J. Ramm, MSN, AGNPa,
- Andrzej S. Kosinski, PhDd,e,
- Paul Sorajja, MDf,
- Jonathan P. Piccini, MD, MHSc,
- Matthew A. Cavender, MD, MPHa and
- John P. Vavalle, MD, MHSa,∗ ()
- aDivision of Cardiology, University of North Carolina, Chapel Hill, North Carolina
- bDivision of Epidemiology, Gillings School of Public Health, University of North Carolina, Chapel Hill, North Carolina
- cDivision of Cardiology, Duke University Medical Center, Durham, North Carolina
- dDuke Clinical Research Institute, Durham, North Carolina
- eDepartment of Biostatistics & Bioinformatics, Duke University School of Medicine, Durham, North Carolina
- fDivision of Cardiology, Valve Science Center, Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota
- ↵∗Address for correspondence:
Dr. John P. Vavalle, University of North Carolina & McAllister Heart Institute, Division of Cardiology, 160 Dental Circle, Chapel Hill, North Carolina 27599-7075.
Objectives The aim of this study was to compare 1-year outcomes following transcatheter mitral valve (MV) repair in patients with and without atrial fibrillation (AF).
Background The development of AF in degenerative mitral regurgitation (MR) is considered a sign of MR progression and is associated with adverse clinical events. However, the impact of AF in patients undergoing transcatheter MV repair remains uncertain.
Methods The TVT (Transcatheter Valve Therapy) Registry was used to identify patients undergoing transcatheter MV repair with the MitraClip between November 2013 and June 2016. Using Centers for Medicare and Medicaid Services–linked data, the 1-year rate of death, heart failure hospitalization, stroke, and bleeding following transcatheter MV repair was compared in patients with and without AF. Outcomes were analyzed using multivariate Cox regression modeling.
Results A total of 5,613 patients underwent commercial transcatheter MV repair in the United States during the study period, including 3,555 (63%) with pre-existing AF. Compared with patients without AF, patients with AF were older, were more likely to be male and Caucasian, had more comorbidities, and had higher Society of Thoracic Surgeons Predicted Risk of Mortality scores (median 7% vs. 5%; p < 0.0001). Acute procedural success (post-procedural ≥2+ MR, 37.4% vs. 35.0%; p = 0.20) and in-hospital mortality were similar, but length of hospital stay was longer for patients with AF (mean 4.91 days vs. 4.37 days; p = 0.0004). A total of 3,261 patients were linked to Centers for Medicare and Medicaid Services claims data. After adjustment, patients with AF had a higher 1-year rate of death or HF (hazard ratio [HR]: 1.27; 95% confidence interval [CI]: 1.11 to 1.44; p < 0.001). Patients with AF had higher rates of mortality (HR: 1.44; 95% CI: 1.22 to 1.70; p < 0.001), HF hospitalization (HR: 1.17; 95% CI: 1.00 to 1.36; p = 0.05), stroke (HR: 1.63; 95% CI: 1.01 to 2.64; p = 0.047), and bleeding (HR: 1.34; 95% CI: 1.10 to 1.64; p = 0.004) at 1 year as well. Among those with AF, the risk for stroke was lower (HR: 0.55; 95% CI: 0.32 to 0.93; p = 0.026) among those on anticoagulation.
Conclusions In patients undergoing transcatheter MV repair, AF is common and is associated with worse clinical outcomes at 1 year despite similar acute procedural success. Further study is needed to investigate if early treatment of MR reduces the future risk for developing AF and to identify therapies that improve outcomes in these patients.
This research was supported by the STS/ACC TVT Registry. The views expressed in this article represent those of the authors and do not necessarily represent the official views of the STS/ACC TVT Registry or the views of its associated professional societies, identified at https://www.sts.org/registries-research-center/stsacc-tvt-registry. Dr. Vemulapalli has received research grants from the American College of Cardiology, the Society of Thoracic Surgeons, the Patient-Centered Outcomes Research Institute, Boston Scientific, and Abbott Vascular; and serves as consultant to Boston Scientific. Ms. Ramm serves on an advisory board for Boston Scientific. Dr. Kosinski has received grants from the American College of Cardiology, the Society of Thoracic Surgeons, and the Patient-Centered Outcomes Research Institute. Dr. Sorajja has received research support from Edwards Lifesciences, Boston Scientific, Abbott, and Medtronic; and serves as consultant to Edwards Lifesciences, Boston Scientific, Abbott, Medtronic, Admedus, and Gore. Dr. Piccini has received funding for clinical research from Abbott Medical, ARCA Biopharma, Boston Scientific, Gilead, and Janssen Pharmaceuticals; and serves as a consultant to Abbott, Allergan, Bayer, Johnson & Johnson, Medtronic, Sanofi, and Phillips. Dr. Cavender has received research support from Abbott Laboratories, AstraZeneca, Chiesi, GlaxoSmithKline, Merck, Novartis, Takeda, and The Medicines Company; and has received consulting fees from AstraZeneca, Boehringer Ingelheim, Chiesi, Janssen, Merck, Novo Nordisk, and Sanofi. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received September 13, 2018.
- Revision received November 27, 2018.
- Accepted December 12, 2018.
- 2019 American College of Cardiology Foundation
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