Coronary artery disease was associated with higher unadjusted all-cause death (25.4% vs 19.6%; P=0.002) after MitraClip implantation, but was not an independent predictor of mortality.
Cohort (n=1,953)
Yes
Does the presence of coronary artery disease worsen outcomes in patients undergoing transcatheter edge-to-edge mitral valve repair with the MitraClip system?
Coronary artery disease does not independently worsen mid-term prognosis after MitraClip implantation, but rather serves as a marker for a more complex patient phenotype with worse baseline clinical status.
Absolute Event Rate: 25.4% vs 19.6%
p-value: p=0.002
BACKGROUND: The clinical impact of coronary artery disease (CAD) on the prognosis of patients undergoing MitraClip implantation is still unclear. METHODS: One thousand nine hundred fifty-three patients undergoing MitraClip implantation included in the multicenter GIOTTO Registry were stratified according to CAD. Endpoints were all-cause death, cardiac death, and re-hospitalization for heart failure at follow-up (median 15.8 months). RESULTS: Although younger, CAD patients were more symptomatic, had worse cardiovascular risk profile, higher burden of comorbidities, more frequently affected by functional MR, with higher left ventricle (LV) diameters and lower ejection fraction (EF). At follow-up, CAD patients showed higher rates of all-cause death (25.4% vs. 19.6%; P=0.002), cardiovascular death (14.0% vs. 10.1%; P=0.007) and re-hospitalization for heart failure (13.9% vs. 10.2%; P=0.011). Dividing the population according to mitral regurgitation (MR) etiology (functional vs. non-functional MR), no differences were observed between CAD and no-CAD patients. At multivariate logistic regression, NYHA III/IV class, prior heart failure hospitalization, severe chronic kidney disease, atrial fibrillation, LV end-diastolic diameter and LVEF<30% but not CAD resulted independent predictors of all-cause death. The same finding was confirmed even after propensity score adjustment. CONCLUSIONS: CAD did not show a relevant impact on mid-term prognosis per se, but seemed to identify a more complex and diseased cohort of patients with worse clinical and functional status.
Giordano et al. (Wed,) conducted a cohort in Mitral regurgitation (n=1,953). Coronary artery disease vs. No coronary artery disease was evaluated on All-cause death (p=0.002). Coronary artery disease was associated with higher unadjusted all-cause death (25.4% vs 19.6%; P=0.002) after MitraClip implantation, but was not an independent predictor of mortality.
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