Impact of atrial fibrillation on outcomes followingMitraClip: A contemporary population-based analysis
- 1 May 2021
- journal article
- research article
- Published by Wiley in Catheterization and Cardiovascular Interventions
- Vol. 97 (6), 1252-1256
- https://doi.org/10.1002/ccd.29310
Abstract
Objectives Despite the rising use of MC, the impact of preexisting AF, a common comorbidity, on short-term postprocedural outcomes is poorly defined. We sought to assess outcomes between patients with and without atrial fibrillation (AF) who underwent percutaneous mitral valve repair with MitraClip (MC). Methods In this retrospective cohort study, the Nationwide Readmissions Database was queried for patients who underwent MC between 2014-2017. Groups were stratified based on the presence of AF. Multivariable logistic regression analyses were performed to identify the association between AF and in-hospital stroke and mortality. Results Of the 15,570 patients who underwent MC, 7,740 (49.7%) had AF. AF patients were older (82 vs. 79 years,p < .001) and more comorbid. Patients with AF relative to without AF demonstrated increased rates of in-hospital ischemic (1.3% vs .0.7%,p < .001) and hemorrhagic stroke (0.3% vs. 0.1%,p= .007), longer duration of hospitalization (median 3 vs. 2 days,p < .001), and similar in-hospital mortality (2.8% vs. 2.6%,p= .52). After adjusting for comorbidities, age, sex, hospital procedural volume, and CHA2DS2-VASc, the presence of AF was associated with higher in-hospital stroke (OR = 2.096, 95%CI[1.503-2.921],p < .001) but not in-hospital mortality (OR = 1.012, 95%CI[0.828-1.238],p= .904). AF patients were more likely to be readmitted (16.8% vs.14.1%,p < .001) and die (1.5% vs. 0.9%,p= .005) within 30 days of discharge despite similar incidences of stroke (0.7% vs. 0.6%,p= .53). Conclusions The increased risk of in-hospital stroke, 30-day mortality, and longer hospitalization suggest the need for increased preprocedural optimization by means of stroke prevention strategies in those with AF undergoing MC.This publication has 19 references indexed in Scilit:
- One-year outcomes and predictors of mortality after MitraClip therapy in contemporary clinical practice: results from the German transcatheter mitral valve interventions registryEuropean Heart Journal, 2015
- The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) Statement: Guidelines for reporting observational studiesInternational Journal of Surgery, 2014
- Percutaneous Mitral Valve Edge-to-Edge RepairJournal of the American College of Cardiology, 2014
- Percutaneous Mitral Valve Repair for Mitral Regurgitation in High-Risk PatientsJournal of the American College of Cardiology, 2014
- Effects of Atrial Fibrillation on Treatment of Mitral Regurgitation in the EVEREST II (Endovascular Valve Edge-to-Edge Repair Study) Randomized TrialJournal of the American College of Cardiology, 2012
- Percutaneous Repair or Surgery for Mitral RegurgitationThe New England Journal of Medicine, 2011
- The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) Statement: Guidelines for Reporting Observational StudiesPLoS Medicine, 2007
- What are the characteristics of patients with severe, symptomatic, mitral regurgitation who are denied surgery?European Heart Journal, 2007
- Burden of valvular heart diseases: a population-based studyThe Lancet, 2006
- Pre-operative atrial fibrillation as the key determinant of outcome of mitral valve repair for degenerative mitral regurgitationEuropean Heart Journal, 2005