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Impact of atrial fibrillation on outcomes following MitraClip: A contemporary population-based analysis

Anas M Saad1, Nicholas Kassis2, Mohamed M Gad2

  • 1Heart and Vascular Institute, Department of Cardiovascular Medicine, Cleveland Clinic Foundation, Cleveland, Ohio, USA.

Catheterization and Cardiovascular Interventions : Official Journal of the Society for Cardiac Angiography & Interventions
|October 5, 2020
PubMed
Abstract

Insights

Patients with atrial fibrillation (AF) undergoing MitraClip (MC) repair face higher risks of stroke and 30-day mortality. Optimization of stroke prevention strategies is crucial for this patient group.

Area of Science:

  • Cardiovascular Medicine
  • Interventional Cardiology
  • Medical Outcomes Research

Background:

  • Atrial fibrillation (AF) is a common comorbidity in patients undergoing cardiac procedures.
  • The impact of AF on short-term outcomes after percutaneous mitral valve repair with MitraClip (MC) is not well-defined.

Purpose of the Study:

  • To assess and compare short-term postprocedural outcomes between patients with and without AF who underwent MC.
  • To identify the association between AF and in-hospital stroke and mortality after MC.

Main Methods:

  • Retrospective cohort study using the Nationwide Readmissions Database (2014-2017).
  • Stratification of patients based on the presence of AF.
  • Multivariable logistic regression analyses to determine the association between AF and in-hospital stroke/mortality.

Main Results:

  • Nearly half (49.7%) of 15,570 MC patients had AF; these patients were older and more comorbid.
  • AF patients had significantly higher rates of in-hospital ischemic and hemorrhagic stroke compared to non-AF patients.
  • Adjusted analyses revealed AF was associated with increased in-hospital stroke (OR=2.096) but not in-hospital mortality. AF patients also experienced longer hospitalizations and higher 30-day readmission and mortality rates.

Conclusions:

  • Patients with AF undergoing MC repair have an elevated risk of in-hospital stroke and 30-day mortality.
  • These findings underscore the need for enhanced preprocedural optimization and stroke prevention strategies for AF patients undergoing MC.
  • Further research into tailored management for AF patients undergoing MitraClip is warranted.
Keywords:
mitral regurgitation.mitral valve repairpercutaneous

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