학술논문
Impact of coronary artery disease on outcome after transcatheter edge-to-edge mitral valve repair with the MitraClip system.
Document Type
Academic Journal
Author
Giordano A; Unit of Invasive Cardiology, Pineta Grande Hospital, Castel Volturno, Caserta, Italy.; Pepe M; Section of Cardiovascular Diseases, Department of Emergency and Organ Transplantation (DETO), University of Bari, Bari, Italy - drmartinopepe@gmail.com.; Biondi-Zoccai G; Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University, Latina, Italy.; Mediterranea Cardiocentro, Naples, Italy.; Corcione N; Unit of Invasive Cardiology, Pineta Grande Hospital, Castel Volturno, Caserta, Italy.; Finizio F; Unit of Invasive Cardiology, Pineta Grande Hospital, Castel Volturno, Caserta, Italy.; Ferraro P; Department of Invasive Cardiology, Casa di Salute Santa Lucia, San Giuseppe Vesuviano, Naples, Italy.; Denti P; Department of Cardiac Surgery, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy.; Popolo Rubbio A; Department of Cardiology, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy.; Petronio S; Cardiac Catheterization Laboratory, Department of Cardiothoracic and Vascular, University Hospital of Pisa, Pisa, Italy.; Bartorelli AL; Centro Cardiologico Monzino, IRCCS, Milan, Italy.; Luigi Sacco Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy.; Nestola PL; Section of Cardiovascular Diseases, Department of Emergency and Organ Transplantation (DETO), University of Bari, Bari, Italy.; Mongiardo A; Division of Cardiology, Magna Graecia University, Catanzaro, Italy.; DE Felice F; Unit of Interventional Cardiology, S. Camillo Forlanini Hospital, Rome, Italy.; Adamo M; Cardiac Catheterization Laboratory, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, ASST Spedali Civili di Brescia, University of Brescia, Brescia, Italy.; Montorfano M; Cardio-Thoracic-Vascular Department, IRCCS San Raffaele Scientific Institute, Milan, Italy.; Baldi C; Department of Interventional Cardiology, San Giovanni e Ruggi University Hospital, Salerno, Italy.; Tarantini G; Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padua, Padua, Italy.; Giannini F; GVM Care & Research Maria Cecilia Hospital, Cotignola, Ravenna, Italy.; Ronco F; Department of Interventional Cardiology, Dell'Angelo Hospital, Mestre, Venice, Italy.; Monteforte I; Unit of Interventional Cardiology, AORN dei Colli, Naples, Italy.; Villa E; Cardiac Surgery and Transcatheter Valve Therapy Group, Poliambulanza Foundation Hospital, Brescia, Italy.; Ferrario Ormezzano M; Division of Cardiology, Policlinico San Matteo IRCCS Foundation, Pavia, Italy.; Fiocca L; Unit of Interventional Cardiology, Cardiovascular Department, Papa Giovanni XXIII Hospital, Bergamo, Italy.; Castriota F; GVM Care & Research Maria Cecilia Hospital, Cotignola, Ravenna, Italy.; Bedogni F; Department of Cardiology, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy.; Tamburino C; Division of Cardiology, G. Rodolico - San Marco Polyclinic Univeristy Hospital, University of Catania, Catania, Italy.
Source
Publisher: Panminerva Medica Country of Publication: Italy NLM ID: 0421110 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1827-1898 (Electronic) Linking ISSN: 00310808 NLM ISO Abbreviation: Panminerva Med Subsets: MEDLINE
Subject
Language
English
Abstract
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.
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.