Pre-existing coronary arterial disease linked to higher rate of myocardial infarction in patients receiving MitraClip

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Pre-existing coronary arterial disease (CAD) was associated with higher in‐hospital acute myocardial infarction (AMI) following implantation of the MitraClip (Abbott) mitral valve device, but with comparable mortality and other morbidities, a study published in the journal Catheterization and Cardiovascular Interventions has reported.

In the study, authors Kristina Gifft (Department of Internal Medicine, University of Missouri Hospital, Columbia, USA) and colleagues, write that percutaneous mitral valve repair with the MitraClip device has been approved for the treatment of symptomatic mitral valve regurgitation in patients deemed high risk. However—they note that it is unclear whether the presence of pre-existing CAD affects the procedural outcomes of the MitraClip device.

The study team used the 2016 Nationwide Readmissions Data (NRD) using the International Classification of Diseases, Tenth Revision, Clincial Modifications/Procedure Coding System (ICD-10-CM/PCS) for MitraClip, pre-existing CAD and postprocedural complications. The study’s primary endpoints included all-cause mortality, cardiogenic shock, acute myocardial infarction (AMI), acute kidney injury (AKI), stroke, acute respiratory failure, length of hospital stay and the 30-day readmission rate.

Researchers identified a total of 2,539 patients that had received the Mitraclip device during the index hospitalisation, of whom 62.3% had history of preexisting CAD. The patients had a mean age of 78.5 years and 46.6% were female.

Overall, the study team writes, the presence of pre-existing CAD was associated with higher AMI (1.6 vs. 0.4%, p<0.01), however, there was no significant differences in terms of in‐hospital all‐cause mortality (2.2 vs. 2.6%, p=0.52), cardiogenic shock (3.4 vs. 4.1%, p=0.39), AKI (14.7 vs. 13.6%, p=0.43), stroke (0.9 vs. 0.5%, p=0.31), acute respiratory failure (9.7 vs. 8.8%, p=0.43), hospital length of stay (5.3 vs. 5.3 days, p=0.85) or 30‐day readmission rate (14.6 vs. 14.4%, p=0.92). These results persisted after adjustment for baseline characteristics, they note.

The study team reports that the subgroup of CAD patients who received percutaneous coronary intervention (PCI) was associated with higher in‐hospital mortality (22.5 vs. 2.0%, p<0.01), cardiogenic shock (25.0 vs. 3.3%, p<0.01), AMI (22.5 vs. 0.8%, p<0.01), AKI (55.0 vs. 13.7%, p<0.01), stroke (10.0 vs. 0.6%, p < .01), acute respiratory failure (45.0 vs. 8.8%, p<0.01), and longer length of hospital stay (21.5 vs. 5.1 days, p < .01). However, there was no significant difference in the 30‐day rate of readmission (15.0 vs. 14.5%, p=0.95).


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