1
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Witberg G, Levi A, Talmor-Barkan Y, Barbanti M, Valvo R, Costa G, Frittitta V, de Backer O, Willemen Y, van Der Dorpel M, Mon M, Sugiura A, Sudo M, Masiero G, Pancaldi E, Arzamendi D, Santos-Martinez S, Baz JA, Steblovnik K, Mauri V, Adam M, Wienemann H, Zahler D, Hein M, Ruile P, Aodha BN, Grasso C, Branca L, Estévez-Loureiro R, Amat-Santos IJ, Mylotte D, Bunc M, Tarantini G, Nombela-Franco L, Sondergaard L, Van Mieghem NM, Finkelstein A, Kornowski R. Outcomes and predictors of left ventricle recovery in patients with severe left ventricular dysfunction undergoing transcatheter aortic valve implantation. EUROINTERVENTION 2024; 20:e487-e495. [PMID: 38629416 PMCID: PMC11017227 DOI: 10.4244/eij-d-23-00948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Accepted: 12/27/2023] [Indexed: 04/19/2024]
Abstract
BACKGROUND Data on the likelihood of left ventricle (LV) recovery in patients with severe LV dysfunction and severe aortic stenosis undergoing transcatheter aortic valve implantation (TAVI) and its prognostic value are limited. AIMS We aimed to assess the likelihood of LV recovery following TAVI, examine its association with midterm mortality, and identify independent predictors of LV function. METHODS In our multicentre registry of 17 TAVI centres in Western Europe and Israel, patients were stratified by baseline LV function (ejection fraction [EF] >/≤30%) and LV response: no LV recovery, LV recovery (EF increase ≥10%), and LV normalisation (EF ≥50% post-TAVI). RESULTS Our analysis included 10,872 patients; baseline EF was ≤30% in 914 (8.4%) patients and >30% in 9,958 (91.6%) patients. The LV recovered in 544 (59.5%) patients, including 244 (26.7%) patients whose LV function normalised completely (EF >50%). Three-year mortality for patients without severe LV dysfunction at baseline was 29.4%. Compared to this, no LV recovery was associated with a significant increase in mortality (adjusted hazard ratio 1.32; p<0.001). Patients with similar LV function post-TAVI had similar rates of 3-year mortality, regardless of their baseline LV function. Three variables were associated with a higher likelihood of LV recovery following TAVI: no previous myocardial infarction (MI), estimated glomerular filtration rate >60 mL/min, and mean aortic valve gradient (mAVG) (expressed either as a continuous variable or as a binary variable using the standard low-flow, low-gradient aortic stenosis [AS] definition). CONCLUSIONS LV recovery following TAVI and the extent of this recovery are major determinants of midterm mortality in patients with severe AS and severe LV dysfunction undergoing TAVI. Patients with no previous MI and those with an mAVG >40 mmHg show the best results following TAVI, which are at least equivalent to those for patients without severe LV dysfunction. (ClinicalTrials.gov: NCT04031274).
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Affiliation(s)
- Guy Witberg
- Department of Cardiology, Rabin Medical Centre, Petah Tikva, Israel and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Amos Levi
- Department of Cardiology, Rabin Medical Centre, Petah Tikva, Israel and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yeela Talmor-Barkan
- Department of Cardiology, Rabin Medical Centre, Petah Tikva, Israel and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Marco Barbanti
- Università degli Studi di Enna Kore, Enna, Italy
- Division of Cardiology, University of Catania, Catania, Italy
| | - Roberto Valvo
- Division of Cardiology, University of Catania, Catania, Italy
| | - Giuliano Costa
- Division of Cardiology, University of Catania, Catania, Italy
| | | | - Ole de Backer
- The Heart Center, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Yannick Willemen
- The Heart Center, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Mark van Der Dorpel
- Department of Cardiology, Thoraxcenter, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Matias Mon
- Cardiovascular Institute. Hospital Clinico San Carlos, IdISSC, Madrid, Spain
| | | | | | - Giulia Masiero
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padua Medical School, Padua, Italy
| | - Edoardo Pancaldi
- Cardiovascular Department, Spedali Civili di Brescia, Brescia, Italy
| | - Dabit Arzamendi
- Hospital de la Santa Creu i Sant Pau Barcelona, Barcelona, Spain
| | | | - Jose A Baz
- Servicio de Cardiología, Hospital Álvaro Cunqueiro, Vigo, Pontevedra, Spain
| | - Klemen Steblovnik
- Department of Cardiology, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Victor Mauri
- Department of Cardiology, Heart Centre, Faculty of Medicine, University of Cologne, Cologne, Germany
| | - Matti Adam
- Department of Cardiology, Heart Centre, Faculty of Medicine, University of Cologne, Cologne, Germany
| | - Hendrik Wienemann
- Department of Cardiology, Heart Centre, Faculty of Medicine, University of Cologne, Cologne, Germany
| | - David Zahler
- Tel Aviv Sourasky Medical Center, Tel Aviv, Israel and School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Manuel Hein
- Department of Cardiology and Angiology II, University Heart Center Freiburg-Bad Krozingen, Bad Krozingen, Germany
| | - Philipp Ruile
- Department of Cardiology and Angiology II, University Heart Center Freiburg-Bad Krozingen, Bad Krozingen, Germany
| | - Brídóg Nic Aodha
- Department of Cardiology, Galway University Hospital and University of Galway, Galway, Ireland
| | - Carmelo Grasso
- Division of Cardiology, University of Catania, Catania, Italy
| | - Luca Branca
- Cardiovascular Department, Spedali Civili di Brescia, Brescia, Italy
| | | | | | - Darren Mylotte
- Department of Cardiology, Galway University Hospital and University of Galway, Galway, Ireland
| | - Matjaz Bunc
- Department of Cardiology, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Giuseppe Tarantini
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padua Medical School, Padua, Italy
| | - Luis Nombela-Franco
- Cardiovascular Institute. Hospital Clinico San Carlos, IdISSC, Madrid, Spain
| | - Lars Sondergaard
- The Heart Center, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Nicolas M Van Mieghem
- Department of Cardiology, Thoraxcenter, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Ariel Finkelstein
- Tel Aviv Sourasky Medical Center, Tel Aviv, Israel and School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ran Kornowski
- Department of Cardiology, Rabin Medical Centre, Petah Tikva, Israel and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
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Sisinni A, Estévez-Loureiro R, Caneiro-Queija B, Barreiro-Pérez M, Baz JA, Pazos P, Gonzalez-Ferreiro R, Iñiguez-Romo A. First-in-Human Treatment of Severe Tricuspid Regurgitation Using a Novel Cross-Caval Heterotopic Device. JACC Case Rep 2023; 28:102103. [PMID: 38204550 PMCID: PMC10774827 DOI: 10.1016/j.jaccas.2023.102103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 09/18/2023] [Accepted: 10/12/2023] [Indexed: 01/12/2024]
Abstract
A 79-year-old woman, previously surgically treated for mitral and aortic valve replacement, experienced recurrent torrential tricuspid regurgitation after 2 transcatheter edge-to-edge repair procedures. Heart team assessment deemed the patient high risk for redo surgery and excluded transcatheter edge-to-edge repair and orthotopic replacement. The patient was then scheduled for a novel cross-caval device implantation.
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Affiliation(s)
- Antonio Sisinni
- Department of Cardiology, University Hospital Alvaro Cunqueiro, Vigo, Spain
- Cardiovascular Research Group, Department of Cardiology, University Hospital Alvaro Cunqueiro, Galicia Sur Health Research Institute (IIS Galicia Sur), Servizo Galego de Saude, University of Vigo, Vigo, Spain
| | - Rodrigo Estévez-Loureiro
- Address for correspondence: Dr Rodrigo Estévez-Loureiro, Department of Cardiology, University Hospital Alvaro Cunqueiro, C/Clara Campoamor 341, 36213 Vigo, Spain. @RodrigoEstvez1
| | - Berenice Caneiro-Queija
- Department of Cardiology, University Hospital Alvaro Cunqueiro, Vigo, Spain
- Cardiovascular Research Group, Department of Cardiology, University Hospital Alvaro Cunqueiro, Galicia Sur Health Research Institute (IIS Galicia Sur), Servizo Galego de Saude, University of Vigo, Vigo, Spain
| | - Manuel Barreiro-Pérez
- Department of Cardiology, University Hospital Alvaro Cunqueiro, Vigo, Spain
- Cardiovascular Research Group, Department of Cardiology, University Hospital Alvaro Cunqueiro, Galicia Sur Health Research Institute (IIS Galicia Sur), Servizo Galego de Saude, University of Vigo, Vigo, Spain
| | - Jose A. Baz
- Department of Cardiology, University Hospital Alvaro Cunqueiro, Vigo, Spain
- Cardiovascular Research Group, Department of Cardiology, University Hospital Alvaro Cunqueiro, Galicia Sur Health Research Institute (IIS Galicia Sur), Servizo Galego de Saude, University of Vigo, Vigo, Spain
| | - Pablo Pazos
- Department of Cardiology, University Hospital Alvaro Cunqueiro, Vigo, Spain
- Cardiovascular Research Group, Department of Cardiology, University Hospital Alvaro Cunqueiro, Galicia Sur Health Research Institute (IIS Galicia Sur), Servizo Galego de Saude, University of Vigo, Vigo, Spain
| | - Rocio Gonzalez-Ferreiro
- Department of Cardiology, University Hospital Alvaro Cunqueiro, Vigo, Spain
- Cardiovascular Research Group, Department of Cardiology, University Hospital Alvaro Cunqueiro, Galicia Sur Health Research Institute (IIS Galicia Sur), Servizo Galego de Saude, University of Vigo, Vigo, Spain
| | - Andrés Iñiguez-Romo
- Department of Cardiology, University Hospital Alvaro Cunqueiro, Vigo, Spain
- Cardiovascular Research Group, Department of Cardiology, University Hospital Alvaro Cunqueiro, Galicia Sur Health Research Institute (IIS Galicia Sur), Servizo Galego de Saude, University of Vigo, Vigo, Spain
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3
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Caneiro-Queija B, Raposeiras-Roubin S, Adamo M, Freixa X, Arzamendi D, Benito-González T, Montefusco A, Pascual I, Nombela-Franco L, Rodes-Cabau J, Shuvy M, Portolés-Hernández A, Godino C, Haberman D, Lupi L, Regueiro A, Li CH, Fernández-Vázquez F, Frea S, Avanzas P, Tirado-Conte G, Paradis JM, Peretz A, Moñivas V, Baz JA, Galasso M, Branca L, Sanchís L, Asmarats L, Garrote-Coloma C, Angelini F, León V, de Agustín JA, Alperi A, Beeri R, Maccagni G, Sabaté M, Fernández-Peregrina E, Gualis J, Bocchino PP, Curello S, Íñiguez-Romo A, Estévez-Loureiro R. Prognostic Impact of Nutritional Status After Transcatheter Edge-to-Edge Mitral Valve Repair: The MIVNUT Registry. J Am Heart Assoc 2022; 11:e023121. [PMID: 36216434 DOI: 10.1161/jaha.121.023121] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Malnutrition is associated with poor prognosis in several cardiovascular diseases. However, its prognostic impact in patients undergoing transcatheter edge-to-edge mitral valve repair (TEER) is not well known. This study sought to assess the prevalence, clinical associations, and prognostic consequences of malnutrition in patients undergoing TEER. Methods and Results A total of 892 patients undergoing TEER from the international MIVNUT (Mitral Valve Repair and Nutritional Status) registry were studied. Malnutrition status was assessed with the Controlling Nutritional Status score. The association of nutritional status with mortality was analyzed with multivariable Cox regression models, whereas the association with heart failure admission was assessed by Fine-Gray models, with death as a competing risk. According to the Controlling Nutritional Status score, 74.4% of patients with TEER had any degree of malnutrition at the time of TEER (75.1% in patients with body mass index <25 kg/m2, 72.1% in those with body mass index ≥25 kg/m2). However, only 20% had moderate-severe malnutrition. TEER was successful in most of patients (94.2%). During a median follow-up of 1.6 years (interquartile range, 0.6-3.0), 267 (29.9%) patients died and 256 patients (28.7%) were admitted for heart failure after TEER. Compared with normal nutritional status moderate-severe malnutrition resulted a strong predictor of mortality (adjusted hazard ratio [HR], 2.1 [95% CI, 1.1-2.4]; P<0.001) and heart failure admission (adjusted subdistribution HR, 1.6 [95% CI, 1.1-2.4]; P=0.015). Conclusions Malnutrition is common among patients submitted to TEER, and moderate-severe malnutrition is strongly associated with increased mortality and heart failure readmission. Assessment of nutritional status in these patients may help to improve risk stratification.
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Affiliation(s)
| | | | - Marianna Adamo
- Cardiac Catheteterization Laboratory, Cardiothoracic Department, Spedali Civili Brescia Brescia Italy
| | | | - Dabit Arzamendi
- Interventional Cardiology Unit, Hospital Sant Pau i Santa Creu Barcelona Spain
| | | | - Antonio Montefusco
- Division of Cardiology, Department of Medical Science University of Turin Città della Salute e Della Scienza Torino Italy
| | - Isaac Pascual
- Interventional Cardiology Unit, Hospital Universitario Central de Asturias Oviedo Spain
| | | | - Josep Rodes-Cabau
- Cardiology Department, Quebec Heart and Lung Institute Laval University Quebec City Canada
| | - Mony Shuvy
- Heart Institute Hadassah-Hebrew University Medical Center Jerusalem Israel
| | | | - Cosmo Godino
- Clinical Cardiology Unit, Faculty of Medicine IRCCS San Raffaele Scientific Institute Milan Italy
| | | | - Laura Lupi
- Cardiac Catheteterization Laboratory, Cardiothoracic Department, Spedali Civili Brescia Brescia Italy
| | | | - Chin Hion Li
- Interventional Cardiology Unit, Hospital Sant Pau i Santa Creu Barcelona Spain
| | | | - Simone Frea
- Division of Cardiology, Department of Medical Science University of Turin Città della Salute e Della Scienza Torino Italy
| | - Pablo Avanzas
- Interventional Cardiology Unit, Hospital Universitario Central de Asturias Oviedo Spain
| | | | - Jean-Michel Paradis
- Cardiology Department, Quebec Heart and Lung Institute Laval University Quebec City Canada
| | - Alona Peretz
- Heart Institute Hadassah-Hebrew University Medical Center Jerusalem Israel
| | - Vanessa Moñivas
- Cardiology Department Hospital Universitario Puerta de Hierro Madrid Spain
| | - Jose A Baz
- Hospital Álvaro Cunqueiro and Instituto de Investigación Sanitaria Galicia Sur Vigo Spain
| | - Michele Galasso
- Hospital Álvaro Cunqueiro and Instituto de Investigación Sanitaria Galicia Sur Vigo Spain
| | - Luca Branca
- Cardiac Catheteterization Laboratory, Cardiothoracic Department, Spedali Civili Brescia Brescia Italy
| | | | - Lluís Asmarats
- Interventional Cardiology Unit, Hospital Sant Pau i Santa Creu Barcelona Spain
| | | | - Filippo Angelini
- Division of Cardiology, Department of Medical Science University of Turin Città della Salute e Della Scienza Torino Italy
| | - Victor León
- Interventional Cardiology Unit, Hospital Universitario Central de Asturias Oviedo Spain
| | - José A de Agustín
- Cardiovascular Institute, Hospital Clinico San Carlos, IdISSC Madrid Spain
| | - Alberto Alperi
- Cardiology Department, Quebec Heart and Lung Institute Laval University Quebec City Canada
| | - Ronen Beeri
- Heart Institute Hadassah-Hebrew University Medical Center Jerusalem Israel
| | - Gloria Maccagni
- Cardiac Catheteterization Laboratory, Cardiothoracic Department, Spedali Civili Brescia Brescia Italy
| | | | | | - Javier Gualis
- Complejo Asistencial Universitario de León León Spain
| | - Pier Paolo Bocchino
- Division of Cardiology, Department of Medical Science University of Turin Città della Salute e Della Scienza Torino Italy
| | - Salvatore Curello
- Cardiac Catheteterization Laboratory, Cardiothoracic Department, Spedali Civili Brescia Brescia Italy
| | - Andrés Íñiguez-Romo
- Hospital Álvaro Cunqueiro and Instituto de Investigación Sanitaria Galicia Sur Vigo Spain
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4
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Busto L, Veiga C, Gonzalez-Novoa JA, Jimenez V, Juan-Salvadores P, Baz JA, Iniguez A. Using artificial intelligence for device identification and characterization in angiographic sequences of TAVI procedures as radiomic biomarkers for prosthesis deterioration. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.2782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Introduction
Transcatheter Aortic Valve Implantation (TAVI) has been established as the preferential option for patients suffering from symptomatic severe aortic stenosis with high surgical risk. Due to the implantation of prosthesis on younger patients, the durability of TAVI devices becomes a crucial issue, especially beyond 5 years of follow-up [1]. Therefore, an application of growing interest is the assessment of the prosthesis deterioration, which is directly related to the measurement of the stent tip deflection [2]. In order to extract this parameter from angiographic sequences, a prior requirement relies on the automatic detection of the prosthesis in the image, pointing directly to the use of Artificial Intelligence.
Purpose
Automatically segment TAVI prostheses in angiographic sequences using Deep Learning [3]. The aim is allowing the extraction of information from these images, as the measurement of the stent tip deflection for evaluating the prosthesis deterioration, to improve the clinical practice.
Methods
A U-Net, which is a Deep Learning architecture designed for the analysis of biomedical imaging, has been trained for the segmentation of TAVI prostheses in angiographies [3]. The self-built dataset includes 50 sequences captured during TAVI from a population of 15 patients, obtaining 2827 frames (examples provided in Fig. 1). This dataset is randomly split into training and test sets using an 80/20 ratio. The U-Net is trained using the training set and its annotations (manually generated), optimised during 50 epochs using Adam optimiser, and binary cross-entropy as the cost function. Once the model has been trained, it is used for the segmentation of the images in the test set.
Results
The segmentation results have been evaluated in separate subsets of frames extracted from the test set, regarding the stage of the procedure they correspond. Such subsets are aortic root previous to the device delivery (Fig. 1A), prosthesis deployment (Fig. 1B), prosthesis fully-expanded (Fig. 1C), and contrast agent injection (Fig. 1D). Fig. 2 provides examples of the results obtained for the images in Fig. 1, showing the original frames and the segmentation result overlaid. The results have been evaluated in terms of different classification metrics, obtaining the mean values in the following ranges for the four groups: accuracy 0.99–1.00, recall 0.70–0.97, and area under the receiver operating characteristic curve (AUROC) 0.85–0.98.
Conclusion
U-Net has been successfully applied to angiographic imaging captured during TAVI procedure for segmenting the prosthesis, with AUROC values between 0.85 and 0.98. The prosthesis identification and characterization allow the extraction of imaging biomarkers of great interest that can be used for the evaluation of the prosthesis deterioration.
Funding Acknowledgement
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Axencia Galega de Innovaciόn (GAIN) (Code Numbers IN845D-2020/29 and IN607B-2021/18)
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Affiliation(s)
- L Busto
- Galicia Sur Health Research Institute , Vigo , Spain
| | - C Veiga
- Galicia Sur Health Research Institute , Vigo , Spain
| | | | - V Jimenez
- Hospital Universitario Alvaro Cunqueiro , Vigo , Spain
| | | | - J A Baz
- Hospital Universitario Alvaro Cunqueiro , Vigo , Spain
| | - A Iniguez
- Hospital Universitario Alvaro Cunqueiro , Vigo , Spain
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5
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Witberg G, Landes U, Talmor-Barkan Y, Richter I, Barbanti M, Valvo R, De Backer O, Ooms JF, Islas F, Marroquin L, Sedaghat A, Sugiura A, Masiero G, Armario X, Fiorina C, Arzamendi D, Santos-Martinez S, Fernández-Vázquez F, Baz JA, Steblovnik K, Mauri V, Adam M, Merdler I, Hein M, Ruile P, Codner P, Grasso C, Branca L, Estévez-Loureiro R, Benito-González T, Amat-Santos IJ, Mylotte D, Bunc M, Tarantini G, Nombela-Franco L, Søndergaard L, Van Mieghem NM, Finkelstein A, Kornowski R. Center Valve Preference and Outcomes of Transcatheter Aortic Valve Replacement: Insights From the AMTRAC Registry. JACC Cardiovasc Interv 2022; 15:1266-1274. [PMID: 35738747 DOI: 10.1016/j.jcin.2022.05.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 04/25/2022] [Accepted: 05/03/2022] [Indexed: 01/02/2023]
Abstract
BACKGROUND Data on outcomes of transcatheter aortic valve replacement (TAVR) using balloon-expandable valves (BEVs) or self-expandable valves (SEVs) as well as the impact of center valve preference on these outcomes are limited. OBJECTIVES The aim of this study was to compare outcomes of TAVR procedures using third-generation BEVs and SEVs stratified by center valve preference. METHODS In a multicenter registry (n = 17), 13 centers exhibited valve preference (66.6%-90% of volume) and were included. Outcomes were compared between BEVs and SEVs stratified by center valve preference. RESULTS In total, 7,528 TAVR procedures (3,854 with SEVs and 3,674 with BEVs) were included. The mean age was 81 years, and the mean Society of Thoracic Surgeons score was 5.2. Baseline characteristics were similar between BEVs and SEVs. Need for pacemaker implantation was higher with SEVs at BEV- and SEV-dominant centers (17.8% vs 9.3% [P < 0.001] and 12.7% vs 10.0% [P = 0.036], respectively; HR: 1.51; P for interaction = 0.021), risk for cerebrovascular accident was higher with SEVs at BEV-dominant but not SEV-dominant centers (3.6% vs 1.1% [P < 0.001] and 2.2% vs 1.4% [P = 0.162]; HR: 2.08; P for interaction < 0.01). Aortic regurgitation greater than mild was more frequent with SEVs at BEV-dominant centers and similar with BEVs regardless of center dominance (5.2% vs 2.8% [P < 0.001] and 3.4% vs 3.7% [P = 0.504], respectively). Two-year mortality was higher with SEVs at BEV-dominant centers but not at SEV-dominant centers (21.9% vs 16.9% [P = 0.021] and 16.8% vs 16.5% [P = 0.642], respectively; HR: 1.20; P for interaction = 0.032). CONCLUSIONS Periprocedural outcomes, aortic regurgitation greater than mild, and 2-year mortality are worse when TAVR is performed using SEVs at BEV-dominant centers. Outcomes are similar regardless of valve type at SEV-dominant centers. The present results stress the need to account for this factor when comparing BEV and SEV outcomes. (The Aortic+Mitral Transcatheter [AMTRAC] Valve Registry; NCT04031274).
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Affiliation(s)
- Guy Witberg
- Department of Cardiology, Rabin Medical Center, Petach-Tikva, Israel; Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
| | - Uri Landes
- Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel; Department of Cardiology, Wolfson Medical Center, Holon, Israel
| | - Yeela Talmor-Barkan
- Department of Cardiology, Rabin Medical Center, Petach-Tikva, Israel; Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Ilan Richter
- Department of Cardiology, Rabin Medical Center, Petach-Tikva, Israel; Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Marco Barbanti
- Division of Cardiology, University of Catania, Catania, Italy
| | - Roberto Valvo
- Division of Cardiology, University of Catania, Catania, Italy
| | - Ole De Backer
- The Heart Center, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Joris F Ooms
- Department of Cardiology, Thoraxcenter, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Fabian Islas
- Cardiovascular Institute, Hospital Clinico San Carlos, IdISSC, Madrid, Spain
| | - Luis Marroquin
- Cardiovascular Institute, Hospital Clinico San Carlos, IdISSC, Madrid, Spain
| | | | | | - Giulia Masiero
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padua Medical School, Padua, Italy
| | - Xavier Armario
- Department of Cardiology, Galway University Hospital, and National University of Ireland Galway, Galway, Ireland
| | | | - Dabit Arzamendi
- Hospital de Sant Creu i Sant Pau Barcelona, Barcelona, Spain
| | | | | | - Jose A Baz
- Servicio de Cardiología, Hospital Álvaro Cunqueiro, Vigo, Pontevedra, Spain
| | - Klemen Steblovnik
- Department of Cardiology, University Medical Center, Ljubljana, Slovenia
| | - Victor Mauri
- Department of Cardiology, Heart Center, Faculty of Medicine, University of Cologne, Germany
| | - Matti Adam
- Department of Cardiology, Heart Center, Faculty of Medicine, University of Cologne, Germany
| | - Ilan Merdler
- Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel; Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel
| | - Manuel Hein
- Department of Cardiology and Angiology II, University Heart Center Freiburg-Bad Krozingen, Bad Krozingen, Germany
| | - Philipp Ruile
- Department of Cardiology and Angiology II, University Heart Center Freiburg-Bad Krozingen, Bad Krozingen, Germany
| | - Pablo Codner
- Department of Cardiology, Rabin Medical Center, Petach-Tikva, Israel; Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Carmelo Grasso
- Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel; Department of Cardiology, Wolfson Medical Center, Holon, Israel
| | - Luca Branca
- Cardiovascular Department, Spedali Civili, Brescia, Italy
| | | | | | | | - Darren Mylotte
- Department of Cardiology, Galway University Hospital, and National University of Ireland Galway, Galway, Ireland
| | - Matjaz Bunc
- Department of Cardiology, University Medical Center, Ljubljana, Slovenia
| | - Giuseppe Tarantini
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padua Medical School, Padua, Italy
| | - Luis Nombela-Franco
- Cardiovascular Institute, Hospital Clinico San Carlos, IdISSC, Madrid, Spain
| | - Lars Søndergaard
- The Heart Center, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Nicolas M Van Mieghem
- Department of Cardiology, Thoraxcenter, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Ariel Finkelstein
- Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel; Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel
| | - Ran Kornowski
- Department of Cardiology, Rabin Medical Center, Petach-Tikva, Israel; Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
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Estévez-Loureiro R, Sánchez-Recalde A, Amat-Santos IJ, Cruz-González I, Baz JA, Pascual I, Mascherbauer J, Abdul-Jawad Altisent O, Nombela-Franco L, Pan M, Trillo R, Moreno R, Delle Karth G, Salido-Tahoces L, Santos-Martinez S, Núñez JC, Moris C, Goliasch G, Jimenez-Quevedo P, Ojeda S, Cid-Álvarez B, Santiago-Vacas E, Jimenez-Valero S, Serrador A, Martín-Moreiras J, Strouhal A, Hengstenberg C, Zamorano JL, Puri R, Íñiguez-Romo A. Six-Month Outcomes of the TricValve® System in Patients with Tricuspid Regurgitation: TRICUS EURO Study. JACC Cardiovasc Interv 2022; 15:1366-1377. [PMID: 35583363 DOI: 10.1016/j.jcin.2022.05.022] [Citation(s) in RCA: 47] [Impact Index Per Article: 23.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 05/10/2022] [Accepted: 05/10/2022] [Indexed: 11/24/2022]
Abstract
BACKGROUND Severe tricuspid regurgitation (TR) is frequently associated with significant morbidity and mortality; such patients often deemed to be at high surgical risk. Heterotopic bi-caval stenting is an emerging, attractive transcatheter solution for these patients. OBJECTIVES To evaluate the 30-day safety and 6-month efficacy outcomes of specifically designed bioprosthetic valves for the superior and inferior vena cava. METHODS TRICUS EURO is a non-blinded, non-randomized, single-arm, multicenter, prospective trial that enrolled patients from 12 European centers between December 2019 to February 2021. High risk individuals with severe symptomatic TR despite optimal medical therapy were included. Primary end point was quality of life (QOL) improvement measured by Kansas City Cardiomyopathy Questionnaire (KCCQ12) and New York Heart Association functional class (NYHA) improvement at 6-month follow-up. RESULTS 35 patients (mean age 76±6.8 years; 83% women) were treated with TricValve® system. All patients at baseline were at NYHA ≥ 3 status. At 30-days, procedural success was 94% with no procedural deaths or conversions to surgery. A significant increase in QOL at 6-months follow-up was observed (baseline and 6-month KCCQ: 42.01±22.3 vs. 59.7±23.6 respectively; p=0.004), correlating with a significant improvement in NYHA functional class with 79.4% of patients noted to be in class I or II at 6 months (p=0.0006). The 6-month all-cause mortality and heart failure hospitalization rates were 8.5% and 20%, respectively. CONCLUSIONS The dedicated bi-caval system for treating severe, symptomatic TR was associated with high procedural success rate and significant increase in both, QOL and functional improvements at 6-months follow-up.
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Affiliation(s)
| | | | | | | | - Jose A Baz
- Complejo Hospitalario Universitario Alvaro Cunqueiro, Vigo, Spain
| | - Isaac Pascual
- Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Julia Mascherbauer
- Division of Cardiology, Department for Internal Medicine II, Medical University of Vienna, Vienna, Austria
| | | | - Luis Nombela-Franco
- Cardiovascular Institute, Hospital Clínico San Carlos, IdISSC, Madrid, Spain
| | - Manuel Pan
- Hospital Universitario Reina Sofia, Córdoba, Spain
| | - Ramiro Trillo
- Hospital Clinico Universitario de Santiago de Compostela, CIBERCV, Santiago, Spain
| | - Raul Moreno
- Hospital Universitario La Paz, Madrid, Spain
| | | | | | | | - Jean C Núñez
- Hospital Clinico Universitario de Salamanca, CIBERCV. IBSAL. Salamanca, Spain
| | - Cesar Moris
- Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Georg Goliasch
- Division of Cardiology, Department for Internal Medicine II, Medical University of Vienna, Vienna, Austria
| | | | | | - Belén Cid-Álvarez
- Hospital Clinico Universitario de Santiago de Compostela, CIBERCV, Santiago, Spain
| | | | | | - Ana Serrador
- CIBERCV. Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | | | | | - Christian Hengstenberg
- Division of Cardiology, Department for Internal Medicine II, Medical University of Vienna, Vienna, Austria
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7
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Castro-Mejía AF, Amat-Santos I, Ortega-Armas ME, Baz JA, Moreno R, Diaz J, Travieso A, Jimenez-Quevedo P, Santos-Martínez S, McInerney A, Galeote G, Díaz VAJ, Garrido JR, Tirado-Conte G, Barrero A, Marroquin L, Nuñez-Gil I, Gonzalo N, Fernandez-Ortiz A, Escaned J, Nombela-Franco L. Development of atrioventricular and intraventricular conduction disturbances in patients undergoing transcatheter aortic valve replacement with new generation self-expanding valves: A real world multicenter analysis. Int J Cardiol 2022; 362:128-136. [PMID: 35550389 DOI: 10.1016/j.ijcard.2022.05.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Revised: 05/01/2022] [Accepted: 05/06/2022] [Indexed: 12/29/2022]
Abstract
BACKGROUND High degree cardiac conduction disturbances (HDCD) remain a major complication after transcatheter aortic valve replacement (TAVR), especially with self-expandable valves (SEV). Our aim was to investigate peri-procedural and in-hospital modification of atrioventricular and intracardiac conduction associated to new generation SEV implantation, and the development of new HDCD resulting in permanent pacemaker implantation (PPM) in patients undergoing TAVR. METHODS AND RESULTS Three-hundred forty-four consecutive patients with severe aortic stenosis who underwent TAVR with a new generation SEV [Evolut-R/Pro (n = 130), Acurate-neo (n = 79), Portico (n = 75) and Allegra (n = 60)] were included. An analysis of baseline, post-TAVR and pre-discharge ECG and procedural aspects were centrally performed. A significant increase in baseline PR interval (169.6 ± 28.2 ms) and QRS complex width (101.7 ± 25.9 ms) was noted immediately post-TAVR (188.04 ± 34.49; 129.55 ± 30.02 ms), with a partial in-hospital reversal (179.4 ± 30.1; 123.06 ± 30.94 ms), resulting in a net increase at hospital discharge of 12.6 ± 38.8 ms and 21.4 ± 31.6 ms (p < 0.001), respectively. The global incidence of new onset persistent HDCD at hospital discharge was 46.3%, with 17.7% of patients requiring PPM. Independent predictors of new onset HCDC at hospital discharge were valve recapture (OR: 2.8; 95% IC: 1.1-7.2, p = 0.033) and implantation depth ≥ 6 mm (OR: 1.9 05% IC 1.1-3.3, p = 0.015), while higher implantation (<3 mm (OR: 0.3, 95% IC 0.1-0.7, p = 0.014) and use of Acurate-Neo valve (OR: 0.4; 95% IC 0.2-0.8, p = 0.009) were protective factor. CONCLUSIONS New generation self-expanding aortic valves were associated with a significant increase in PR and QRS interval at hospital discharge leading to a very high rate of HDCD. While valve recapture and implantation depth were independent predictors for the occurrence of HDCD, use of Accurate-Neo valve was a protective factor.
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Affiliation(s)
- Alex F Castro-Mejía
- Cardiovascular Institute, Hospital Clínico San Carlos, IdISSC, Universidad Complutense de Madrid, Madrid, Spain
| | - Ignacio Amat-Santos
- Servicio de Cardiología, Hospital Clínico Universitario, Valladolid, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain
| | - Maria E Ortega-Armas
- Cardiovascular Institute, Hospital Clínico San Carlos, IdISSC, Universidad Complutense de Madrid, Madrid, Spain
| | - Jose A Baz
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Servicio de Cardiología, Hospital Álvaro Cunqueiro, Vigo, Spain
| | - Raúl Moreno
- Servicio de Cardiología, Hospital Universitario La Paz, Madrid, Spain
| | - Jose Diaz
- Hospital Juan Ramón Jimenez, Huelva, Spain
| | - Alejandro Travieso
- Cardiovascular Institute, Hospital Clínico San Carlos, IdISSC, Universidad Complutense de Madrid, Madrid, Spain
| | - Pilar Jimenez-Quevedo
- Cardiovascular Institute, Hospital Clínico San Carlos, IdISSC, Universidad Complutense de Madrid, Madrid, Spain
| | - Sandra Santos-Martínez
- Servicio de Cardiología, Hospital Clínico Universitario, Valladolid, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain
| | - Angela McInerney
- Cardiovascular Institute, Hospital Clínico San Carlos, IdISSC, Universidad Complutense de Madrid, Madrid, Spain
| | - Guillermo Galeote
- Servicio de Cardiología, Hospital Universitario La Paz, Madrid, Spain
| | - Victor Alfonso Jimenez Díaz
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Servicio de Cardiología, Hospital Álvaro Cunqueiro, Vigo, Spain
| | | | - Gabriela Tirado-Conte
- Cardiovascular Institute, Hospital Clínico San Carlos, IdISSC, Universidad Complutense de Madrid, Madrid, Spain
| | - Alejandro Barrero
- Servicio de Cardiología, Hospital Clínico Universitario, Valladolid, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain
| | - Luis Marroquin
- Cardiovascular Institute, Hospital Clínico San Carlos, IdISSC, Universidad Complutense de Madrid, Madrid, Spain
| | - Ivan Nuñez-Gil
- Cardiovascular Institute, Hospital Clínico San Carlos, IdISSC, Universidad Complutense de Madrid, Madrid, Spain
| | - Nieves Gonzalo
- Cardiovascular Institute, Hospital Clínico San Carlos, IdISSC, Universidad Complutense de Madrid, Madrid, Spain
| | - Antonio Fernandez-Ortiz
- Cardiovascular Institute, Hospital Clínico San Carlos, IdISSC, Universidad Complutense de Madrid, Madrid, Spain
| | - Javier Escaned
- Cardiovascular Institute, Hospital Clínico San Carlos, IdISSC, Universidad Complutense de Madrid, Madrid, Spain
| | - Luis Nombela-Franco
- Cardiovascular Institute, Hospital Clínico San Carlos, IdISSC, Universidad Complutense de Madrid, Madrid, Spain.
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8
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Witberg G, Landes U, Codner P, Barbanti M, Valvo R, De Backer O, Ooms JF, McInerney A, Masiero G, Werner P, Armario X, Fiorina C, Arzamendi D, Santos-Martinez S, Baz JA, Steblovnik K, Mauri V, Adam M, Merdler I, Hein M, Ruile P, Russo M, Musumeci F, Sedaghat A, Sugiura A, Grasso C, Branca L, Estévez-Loureiro R, Amat-Santos IJ, Mylotte D, Andreas M, Bunc M, Tarantini G, Nombela-Franco L, Søndergaard L, Van Mieghem NM, Finkelstein A, Kornowski R. Clinical outcomes of transcatheter aortic valve implantation in patients younger than 70 years rejected for surgery: the AMTRAC registry. EUROINTERVENTION 2022; 17:1289-1297. [PMID: 34673502 PMCID: PMC9743236 DOI: 10.4244/eij-d-21-00613] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND The mean age of transcatheter aortic valve implantation (TAVI) patients is steadily decreasing. AIMS The aim of the study was to describe the characteristics, the indications for and the outcomes of TAVI in patients <70 years old. METHODS All patients undergoing TAVI (n=8,626) from the 18 participating centres between January 2007 and June 2020 were stratified by age (</>70). For patients <70, the indications for TAVI were extracted from Heart Team discussions and the baseline characteristics and mortality were compared between the two groups. RESULTS Overall, 640 (7.4%) patients were <70 (9.1% during 2018-2020, p<0.001); the mean age was 65.0±2.3 years. The younger patients were more often male, with bicuspid valves or needing valve-in-valve procedures. They had a higher prevalence of lung disease and diabetes. In 80.7% of cases, the Heart Team estimated an increased surgical risk and TAVI was selected, reflected by an STS score >4% in 20.4%. Five-year mortality was similar (29.4 vs 29.8%, HR 0.95, p=0.432) in the <70 and >70 groups. In the <70 group, mortality was higher for those referred for TAVI due to an increased surgical risk compared to those referred for other reasons (31.6 vs 24.5%, HR 1.23, p=0.021). Mortality was similar regardless of the STS stratum in patients judged by the Heart Team to be at increased surgical risk (32.6 vs 30.4%, HR 0.98, p=0.715). CONCLUSIONS Use of TAVI in patients <70 is becoming more frequent. The main reason for choosing TAVI is due to an increased surgical risk not adequately represented by the STS score. The outcomes for these patients are similar to those for older TAVI patients. Dedicated trials of TAVI/SAVR in younger patients are needed to guide decisions concerning expansion of TAVI indications. ((ClinicalTrials.gov: NCT04031274).
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Affiliation(s)
- Guy Witberg
- Division of Cardiology, Rabin Medical Centre, Petah-Tikva, Israel.,The Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Uri Landes
- Division of Cardiology, Rabin Medical Centre, Petah-Tikva, Israel.,The Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Pablo Codner
- Division of Cardiology, Rabin Medical Centre, Petah-Tikva, Israel.,The Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Marco Barbanti
- Division of Cardiology, University of Catania, Catania, Italy
| | - Roberto Valvo
- Division of Cardiology, University of Catania, Catania, Italy
| | - Ole De Backer
- The Heart Center, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Joris F Ooms
- Department of Cardiology, Thoraxcenter, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Angela McInerney
- Cardiovascular Institute, Hospital Clinico San Carlos, IdISSC, Madrid, Spain
| | - Giulia Masiero
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padua Medical School, Padua, Italy
| | - Paul Werner
- Division of Cardiac Surgery, Medical University of Vienna, Vienna, Austria
| | - Xavier Armario
- Department of Cardiology, University Hospital Galway, National University of Ireland, Galway, Ireland
| | | | - Dabit Arzamendi
- Hospital de Sant Creu i Sant Pau Barcelona, Barcelona, Spain
| | | | - Jose A Baz
- Servicio de Cardiología, Hospital Álvaro Cunqueiro, Vigo, Pontevedra, Spain
| | - Klemen Steblovnik
- Department of Cardiology, University Medical Centre, Ljubljana, Slovenia
| | - Victor Mauri
- Department of Cardiology, Heart Centre, Faculty of Medicine, University of Cologne, Cologne, Germany
| | - Matti Adam
- Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Ilan Merdler
- Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Manuel Hein
- Department of Cardiology and Angiology II, University Heart Center Freiburg-Bad Krozingen, Bad Krozingen, Germany
| | - Philipp Ruile
- Department of Cardiology and Angiology II, University Heart Center Freiburg-Bad Krozingen, Bad Krozingen, Germany
| | | | | | | | | | - Carmelo Grasso
- Division of Cardiology, University of Catania, Catania, Italy
| | - Luca Branca
- Cardiovascular Department, Spedali Civili, Brescia, Italy
| | | | | | - Darren Mylotte
- Department of Cardiology, University Hospital Galway, National University of Ireland, Galway, Ireland
| | - Martin Andreas
- Division of Cardiac Surgery, Medical University of Vienna, Vienna, Austria
| | - Matjaž Bunc
- Department of Cardiology, University Medical Centre, Ljubljana, Slovenia
| | - Giuseppe Tarantini
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padua Medical School, Padua, Italy
| | - Luis Nombela-Franco
- Cardiovascular Institute, Hospital Clinico San Carlos, IdISSC, Madrid, Spain
| | - Lars Søndergaard
- The Heart Center, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Nicolas M Van Mieghem
- Department of Cardiology, Thoraxcenter, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Ariel Finkelstein
- The Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.,Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Ran Kornowski
- Division of Cardiology, Rabin Medical Centre, Petah-Tikva, Israel.,The Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
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9
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Raposeiras-Roubin S, Adamo M, Freixa X, Arzamendi D, Benito-González T, Montefusco A, Pascual I, Nombela-Franco L, Rodes-Cabau J, Shuvy M, Portolés-Hernández A, Godino C, Caneiro-Queija B, Lupi L, Regueiro A, Li CH, Fernández-Vázquez F, Frea S, Avanzas P, Tirado-Conte G, Paradis JM, Peretz A, Moñivas V, Baz JA, Galasso M, Branca L, Sanchís L, Asmarats L, Garrote-Coloma C, Angelini F, León V, Pozo E, Alperi A, Beeri R, Cani D, Sabaté M, Fernández-Peregrina E, Gualis J, Bocchino PP, Curello S, Abu-Assi E, Íñiguez-Romo A, Bedogni F, Rubbio AP, Testa L, Grasso C, Estévez-Loureiro R. A Score to Assess Mortality After Percutaneous Mitral Valve Repair. J Am Coll Cardiol 2022; 79:562-573. [PMID: 35144748 DOI: 10.1016/j.jacc.2021.11.041] [Citation(s) in RCA: 37] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Revised: 11/04/2021] [Accepted: 11/08/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND Risk stratification for transcatheter edge-to-edge mitral valve repair (TEER) is paramount in the decision-making process for treating severe mitral regurgitation (MR). OBJECTIVES This study sought to create and validate a user-friendly score (MitraScore) to predict the risk of mortality in patients undergoing TEER. METHODS The derivation cohort was based on a multicentric international registry that included 1,119 patients referred for TEER between 2012 and 2020. Score discrimination was assessed using Harrell's c-statistic, and the calibration was evaluated with the Gronnesby and Borgan goodness-of-fit test. An external validation was carried out in 725 patients from the GIOTTO registry. RESULTS After multivariate analysis, we identified 8 independent predictors of mortality during the follow-up (2.1 ± 1.8 years): age ≥75 years, anemia, glomerular filtrate rate <60 mL/min/1.73 m2, left ventricular ejection fraction <40%, peripheral artery disease, chronic obstructive pulmonary disease, high diuretic dose, and no therapy with renin-angiotensin system inhibitors. The MitraScore was derived by assigning 1 point to each independent predictor. The c-statistic was 0.70. Per each point of the MitraScore, the relative risk of mortality increased by 55% (HR: 1.55; 95% CI: 1.44-1.67; P < 0.001). The discrimination and calibration for mortality prediction was better than those of EuroSCORE II (c-statistic 0.61) or Society of Thoracic Surgeons score (c-statistic 0.57). The MitraScore maintained adequate performance in the validation cohort (c-statistic 0.66). The score was also predictive for heart failure rehospitalization and was correlated with the probability of clinical improvement. CONCLUSIONS The MitraScore is a simple prediction algorithm for the prediction of follow-up mortality in patients treated with TEER.
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Affiliation(s)
| | - Marianna Adamo
- Cardiac Catheteterization Laboratory, Cardiothoracic Department, Spedali Civili Brescia, Brescia, Italy
| | | | - Dabit Arzamendi
- Interventional Cardiology Unit, Hospital Sant Pau i Santa Creu, Barcelona, Spain
| | | | - Antonio Montefusco
- Division of Cardiology, Department of Medical Science, University of Turin, Città della Salute e Della Scienza, Turin, Italy
| | - Isaac Pascual
- Interventional Cardiology Unit, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Luis Nombela-Franco
- Cardiovascular Institute, Hospital Clinico San Carlos, IdISSC, Madrid, Spain
| | - Josep Rodes-Cabau
- Cardiology Department, Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada
| | - Mony Shuvy
- Heart Institute, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | | | - Cosmo Godino
- Clinical Cardiology Unit, Faculty of Medicine, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | | | - Laura Lupi
- Cardiac Catheteterization Laboratory, Cardiothoracic Department, Spedali Civili Brescia, Brescia, Italy
| | | | - Chin Hion Li
- Interventional Cardiology Unit, Hospital Sant Pau i Santa Creu, Barcelona, Spain
| | | | - Simone Frea
- Division of Cardiology, Department of Medical Science, University of Turin, Città della Salute e Della Scienza, Turin, Italy
| | - Pablo Avanzas
- Interventional Cardiology Unit, Hospital Universitario Central de Asturias, Oviedo, Spain
| | | | - Jean-Michel Paradis
- Cardiology Department, Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada
| | - Alona Peretz
- Heart Institute, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Vanessa Moñivas
- Cardiology Department, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid
| | | | - Michele Galasso
- Clinical Cardiology Unit, Faculty of Medicine, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Luca Branca
- Cardiac Catheteterization Laboratory, Cardiothoracic Department, Spedali Civili Brescia, Brescia, Italy
| | | | - Lluís Asmarats
- Interventional Cardiology Unit, Hospital Sant Pau i Santa Creu, Barcelona, Spain
| | | | - Filippo Angelini
- Division of Cardiology, Department of Medical Science, University of Turin, Città della Salute e Della Scienza, Turin, Italy
| | - Victor León
- Interventional Cardiology Unit, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Eduardo Pozo
- Cardiovascular Institute, Hospital Clinico San Carlos, IdISSC, Madrid, Spain
| | - Alberto Alperi
- Cardiology Department, Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada
| | - Ronen Beeri
- Heart Institute, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Dario Cani
- Cardiac Catheteterization Laboratory, Cardiothoracic Department, Spedali Civili Brescia, Brescia, Italy
| | | | | | - Javier Gualis
- Complejo Asistencial Universitario de León, León, Spain
| | - Pier Paolo Bocchino
- Division of Cardiology, Department of Medical Science, University of Turin, Città della Salute e Della Scienza, Turin, Italy
| | - Salvatore Curello
- Cardiac Catheteterization Laboratory, Cardiothoracic Department, Spedali Civili Brescia, Brescia, Italy
| | | | | | - Francesco Bedogni
- Department of Cardiology, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Antonio Popolo Rubbio
- Division of Cardiology, Centro Alte Specialità e Trapianti (CAST), Azienda Ospedaliero-Universitaria Policlinico-Vittorio Emanuele, University of Catania, Catania, Italy
| | - Luca Testa
- Department of Cardiology, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Carmelo Grasso
- Division of Cardiology, Centro Alte Specialità e Trapianti (CAST), Azienda Ospedaliero-Universitaria Policlinico-Vittorio Emanuele, University of Catania, Catania, Italy
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10
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Raposeiras-Roubin S, Adamo M, Freixa X, Arzamendi D, Benito-González T, Montefusco A, Pascual I, Nombela-Franco L, Rodes-Cabau J, Shuvy M, Portolés-Hernández A, Godino C, Caneiro-Queija B, Lupi L, Regueiro A, Li CH, Fernández-Vázquez F, Frea S, Avanzas P, Tirado-Conte G, Paradis JM, Peretz A, Moñivas V, Baz JA, Galasso M, Branca L, Sanchís L, Asmarats L, Garrote-Coloma C, Angelini F, León V, Pozo E, Alperi A, Beeri R, Cani D, Sabaté M, Fernández-Peregrina E, Gualis J, Bocchino PP, Curello S, Abu-Assi E, Íñiguez-Romo A, Bedogni F, Rubbio AP, Testa L, Grasso C, Estévez-Loureiro R. A Score to Assess Mortality After Percutaneous Mitral Valve Repair. J Am Coll Cardiol 2022; 79:562-573. [PMID: 35144748 DOI: 10.1016/j.jacc.2021.11] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Revised: 11/04/2021] [Accepted: 11/08/2021] [Indexed: 05/20/2023]
Abstract
BACKGROUND Risk stratification for transcatheter edge-to-edge mitral valve repair (TEER) is paramount in the decision-making process for treating severe mitral regurgitation (MR). OBJECTIVES This study sought to create and validate a user-friendly score (MitraScore) to predict the risk of mortality in patients undergoing TEER. METHODS The derivation cohort was based on a multicentric international registry that included 1,119 patients referred for TEER between 2012 and 2020. Score discrimination was assessed using Harrell's c-statistic, and the calibration was evaluated with the Gronnesby and Borgan goodness-of-fit test. An external validation was carried out in 725 patients from the GIOTTO registry. RESULTS After multivariate analysis, we identified 8 independent predictors of mortality during the follow-up (2.1 ± 1.8 years): age ≥75 years, anemia, glomerular filtrate rate <60 mL/min/1.73 m2, left ventricular ejection fraction <40%, peripheral artery disease, chronic obstructive pulmonary disease, high diuretic dose, and no therapy with renin-angiotensin system inhibitors. The MitraScore was derived by assigning 1 point to each independent predictor. The c-statistic was 0.70. Per each point of the MitraScore, the relative risk of mortality increased by 55% (HR: 1.55; 95% CI: 1.44-1.67; P < 0.001). The discrimination and calibration for mortality prediction was better than those of EuroSCORE II (c-statistic 0.61) or Society of Thoracic Surgeons score (c-statistic 0.57). The MitraScore maintained adequate performance in the validation cohort (c-statistic 0.66). The score was also predictive for heart failure rehospitalization and was correlated with the probability of clinical improvement. CONCLUSIONS The MitraScore is a simple prediction algorithm for the prediction of follow-up mortality in patients treated with TEER.
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Affiliation(s)
| | - Marianna Adamo
- Cardiac Catheteterization Laboratory, Cardiothoracic Department, Spedali Civili Brescia, Brescia, Italy
| | | | - Dabit Arzamendi
- Interventional Cardiology Unit, Hospital Sant Pau i Santa Creu, Barcelona, Spain
| | | | - Antonio Montefusco
- Division of Cardiology, Department of Medical Science, University of Turin, Città della Salute e Della Scienza, Turin, Italy
| | - Isaac Pascual
- Interventional Cardiology Unit, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Luis Nombela-Franco
- Cardiovascular Institute, Hospital Clinico San Carlos, IdISSC, Madrid, Spain
| | - Josep Rodes-Cabau
- Cardiology Department, Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada
| | - Mony Shuvy
- Heart Institute, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | | | - Cosmo Godino
- Clinical Cardiology Unit, Faculty of Medicine, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | | | - Laura Lupi
- Cardiac Catheteterization Laboratory, Cardiothoracic Department, Spedali Civili Brescia, Brescia, Italy
| | | | - Chin Hion Li
- Interventional Cardiology Unit, Hospital Sant Pau i Santa Creu, Barcelona, Spain
| | | | - Simone Frea
- Division of Cardiology, Department of Medical Science, University of Turin, Città della Salute e Della Scienza, Turin, Italy
| | - Pablo Avanzas
- Interventional Cardiology Unit, Hospital Universitario Central de Asturias, Oviedo, Spain
| | | | - Jean-Michel Paradis
- Cardiology Department, Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada
| | - Alona Peretz
- Heart Institute, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Vanessa Moñivas
- Cardiology Department, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid
| | | | - Michele Galasso
- Clinical Cardiology Unit, Faculty of Medicine, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Luca Branca
- Cardiac Catheteterization Laboratory, Cardiothoracic Department, Spedali Civili Brescia, Brescia, Italy
| | | | - Lluís Asmarats
- Interventional Cardiology Unit, Hospital Sant Pau i Santa Creu, Barcelona, Spain
| | | | - Filippo Angelini
- Division of Cardiology, Department of Medical Science, University of Turin, Città della Salute e Della Scienza, Turin, Italy
| | - Victor León
- Interventional Cardiology Unit, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Eduardo Pozo
- Cardiovascular Institute, Hospital Clinico San Carlos, IdISSC, Madrid, Spain
| | - Alberto Alperi
- Cardiology Department, Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada
| | - Ronen Beeri
- Heart Institute, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Dario Cani
- Cardiac Catheteterization Laboratory, Cardiothoracic Department, Spedali Civili Brescia, Brescia, Italy
| | | | | | - Javier Gualis
- Complejo Asistencial Universitario de León, León, Spain
| | - Pier Paolo Bocchino
- Division of Cardiology, Department of Medical Science, University of Turin, Città della Salute e Della Scienza, Turin, Italy
| | - Salvatore Curello
- Cardiac Catheteterization Laboratory, Cardiothoracic Department, Spedali Civili Brescia, Brescia, Italy
| | | | | | - Francesco Bedogni
- Department of Cardiology, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Antonio Popolo Rubbio
- Division of Cardiology, Centro Alte Specialità e Trapianti (CAST), Azienda Ospedaliero-Universitaria Policlinico-Vittorio Emanuele, University of Catania, Catania, Italy
| | - Luca Testa
- Department of Cardiology, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Carmelo Grasso
- Division of Cardiology, Centro Alte Specialità e Trapianti (CAST), Azienda Ospedaliero-Universitaria Policlinico-Vittorio Emanuele, University of Catania, Catania, Italy
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Freixa X, Estévez‐Loureiro R, Pascual I, Carrasco‐Chinchilla F, Sanchis L, Nombela‐Franco L, Benito T, Li P, Flores‐Umanzor E, Amat‐Santos I, Baz JA, Jiménez‐Quevedo P, Hernández F, Fernández‐Peregrina E, Alonso‐Briales JH, Avanzas P, Fernández‐Vazquez F, Arzamendi D. Procedural and clinical outcomes after repeat edge‐to‐edge transcatheter mitral valve repair. Catheter Cardiovasc Interv 2022; 99:1619-1625. [DOI: 10.1002/ccd.30053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Revised: 10/23/2021] [Accepted: 11/27/2021] [Indexed: 11/09/2022]
Affiliation(s)
- Xavier Freixa
- Hospital Clinic de Barcelona Institut Clínic Cardiovascular Barcelona Spain
| | | | | | | | - Laura Sanchis
- Hospital Clinic de Barcelona Institut Clínic Cardiovascular Barcelona Spain
| | | | | | - Pedro Li
- Hospital de la Santa Creu i Sant Pau Barcelona Spain
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Witberg G, Codner P, Landes U, Barbanti M, Valvo R, De Backer O, Ooms JF, Sievert K, El Sabbagh A, Jimenez-Quevedo P, Brennan PF, Sedaghat A, Masiero G, Werner P, Overtchouk P, Watanabe Y, Montorfano M, Bijjam VR, Hein M, Fiorina C, Arzamendi D, Rodriguez-Gabella T, Fernández-Vázquez F, Baz JA, Laperche C, Grasso C, Branca L, Estévez-Loureiro R, Benito-González T, Amat Santos IJ, Ruile P, Mylotte D, Buzzatti N, Piazza N, Andreas M, Tarantini G, Sinning JM, Spence MS, Nombela-Franco L, Guerrero M, Sievert H, Sondergaard L, Van Mieghem NM, Tchetche D, Webb JG, Kornowski R. Transcatheter Treatment of Residual Significant Mitral Regurgitation Following TAVR: A Multicenter Registry. JACC Cardiovasc Interv 2021; 13:2782-2791. [PMID: 33303117 DOI: 10.1016/j.jcin.2020.07.014] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 06/01/2020] [Accepted: 07/07/2020] [Indexed: 11/27/2022]
Abstract
OBJECTIVES The aim of this study was to describe baseline characteristics, and periprocedural and mid-term outcomes of patients undergoing transcatheter mitral valve interventions post-transcatheter aortic valve replacement (TAVR) and examine their clinical benefit. BACKGROUND The optimal management of residual mitral regurgitation (MR) post-TAVR is challenging. METHODS This was an international registry of 23 TAVR centers. RESULTS In total, 106 of 24,178 patients (0.43%) underwent mitral interventions post-TAVR (100 staged, 6 concomitant), most commonly percutaneous edge-to-edge mitral valve repair (PMVR). The median interval post-TAVR was 164 days. Mean age was 79.5 ± 7.2 years, MR was >moderate in 97.2%, technical success was 99.1%, and 30-day device success rate was 88.7%. There were 18 periprocedural complications (16.9%) including 4 deaths. During a median follow-up of 464 days, the cumulative risk for 3-year mortality was 29.0%. MR grade and New York Heart Association (NYHA) functional class improved dramatically; at 1 year, MR was moderate or less in 90.9% of patients (mild or less in 69.1%), and 85.9% of patients were in NYHA functional class I/II. Staged PMVR was associated with lower mortality versus medical treatment (57.5% vs. 30.8%) in a propensity-matched cohort (n = 156), but this was not statistically significant (hazard ratio: 1.75; p = 0.05). CONCLUSIONS For patients who continue to have significant MR, remain symptomatic post-TAVR, and are anatomically suitable for transcatheter interventions, these interventions are feasible, safe, and associated with significant improvement in MR grade and NYHA functional class. These results apply mainly to PMVR. A staged PMVR strategy was associated with markedly lower mortality, but this was not statistically significant. (Transcatheter Treatment for Combined Aortic and Mitral Valve Disease. The Aortic+Mitral TRAnsCatheter Valve Registry [AMTRAC]; NCT04031274).
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Affiliation(s)
- Guy Witberg
- Department of Cardiology, Rabin Medical Centre, Petach-Tikva, Israel; Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
| | - Pablo Codner
- Department of Cardiology, Rabin Medical Centre, Petach-Tikva, Israel; Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Uri Landes
- Department of Cardiology, Rabin Medical Centre, Petach-Tikva, Israel; Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel; St. Paul's Hospital, Vancouver, British Columbia, Canada
| | - Marco Barbanti
- Division of Cardiology, University of Catania, Catania, Italy
| | - Roberto Valvo
- Division of Cardiology, University of Catania, Catania, Italy
| | - Ole De Backer
- The Heart Center, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Joris F Ooms
- Department of Cardiology, Thoraxcenter, Erasmus University Medical Center, Rotterdam, the Netherlands
| | | | - Abdallah El Sabbagh
- Department of Cardiovascular Medicine, Mayo Clinic Hospital, Rochester, Minnesota, USA
| | | | - Paul F Brennan
- Department of Cardiology, Royal Victoria Hospital, Belfast Health & Social Care Trust, Belfast, United Kingdom
| | | | - Giulia Masiero
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padua Medical School, Padua, Italy
| | - Paul Werner
- Division of Cardiac Surgery Medical University of Vienna, Vienna, Austria
| | - Pavel Overtchouk
- Department of Medicine, Division of Cardiology, McGill University Health Centre, Royal Victoria Hospital, Montreal, Quebec, Canada
| | - Yusuke Watanabe
- Department of Cardiology, Teikyo University School of Medicine, Tokyo, Japan
| | - Matteo Montorfano
- Department of Interventional Cardiology, San Raffaele Scientific Institute, Milan Italy
| | - Venu Reddy Bijjam
- Department of Cardiology, University Hospital, and National University of Ireland Galway, Galway, Ireland
| | - Manuel Hein
- Department of Cardiology and Angiology II, University Heart Center Freiburg-Bad Krozingen, Bad Krozingen, Germany
| | | | - Dabit Arzamendi
- Hospital de Sant Creu i Sant Pau Barcelona, Barcelona, Spain
| | | | | | - Jose A Baz
- Servicio de Cardiología, Hospital Álvaro Cunqueiro, Vigo, Pontevedra, Spain
| | - Clemence Laperche
- Department of Interventional Cardiology, Clinique Pasteur, Toulouse, France
| | - Carmelo Grasso
- Division of Cardiology, University of Catania, Catania, Italy
| | - Luca Branca
- Cardiovascular Department, Spedali Civili, Brescia, Italy
| | | | | | | | - Philipp Ruile
- Department of Cardiology and Angiology II, University Heart Center Freiburg-Bad Krozingen, Bad Krozingen, Germany
| | - Darren Mylotte
- Department of Cardiology, University Hospital, and National University of Ireland Galway, Galway, Ireland
| | - Nicola Buzzatti
- Department of Interventional Cardiology, San Raffaele Scientific Institute, Milan Italy
| | - Nicolo Piazza
- Department of Medicine, Division of Cardiology, McGill University Health Centre, Royal Victoria Hospital, Montreal, Quebec, Canada
| | - Martin Andreas
- Division of Cardiac Surgery Medical University of Vienna, Vienna, Austria
| | - Giuseppe Tarantini
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padua Medical School, Padua, Italy
| | | | - Mark S Spence
- Department of Cardiology, Royal Victoria Hospital, Belfast Health & Social Care Trust, Belfast, United Kingdom
| | - Luis Nombela-Franco
- Cardiovascular Institute. Hospital Clinico San Carlos, IdISSC, Madrid, Spain
| | - Mayra Guerrero
- Department of Cardiovascular Medicine, Mayo Clinic Hospital, Rochester, Minnesota, USA
| | - Horst Sievert
- Cardiovascular Center Frankfurt, Frankfurt, Germany; Anglia Ruskin University, Chelmsford, United Kingdom; University of California San Francisco, San Francisco, California, USA; Yunnan Hospital Fuwai, Kunming, China
| | - Lars Sondergaard
- The Heart Center, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Nicolas M Van Mieghem
- Department of Cardiology, Thoraxcenter, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Didier Tchetche
- Department of Interventional Cardiology, Clinique Pasteur, Toulouse, France
| | - John G Webb
- Centre for Heart Valve Innovation, St. Paul's Hospital, Vancouver, British Columbia, Canada
| | - Ran Kornowski
- Department of Cardiology, Rabin Medical Centre, Petach-Tikva, Israel; Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
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Witberg G, Codner P, Landes U, Schwartzenberg S, Barbanti M, Valvo R, De Backer O, Ooms JF, Islas F, Marroquin L, Sedaghat A, Sugiura A, Masiero G, Werner P, Armario X, Fiorina C, Arzamendi D, Santos-Martinez S, Fernández-Vázquez F, Baz JA, Steblovnik K, Mauri V, Adam M, Merdler I, Hein M, Ruile P, Grasso C, Branca L, Estévez-Loureiro R, Benito-González T, Amat-Santos IJ, Mylotte D, Andreas M, Bunc M, Tarantini G, Sinning JM, Nombela-Franco L, Søndergaard L, Van Mieghem NM, Finkelstein A, Kornowski R. Effect of Transcatheter Aortic Valve Replacement on Concomitant Mitral Regurgitation and Its Impact on Mortality. JACC Cardiovasc Interv 2021; 14:1181-1192. [PMID: 33992550 DOI: 10.1016/j.jcin.2021.02.030] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Revised: 02/11/2021] [Accepted: 02/16/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVES The purpose of this study was to examine the impact of residual mitral regurgitation (MR) on mortality in patients undergoing transcatheter aortic valve replacement (TAVR). BACKGROUND MR is common in patients undergoing TAVR. Data on optimal management of patients with significant MR after TAVR are limited. METHODS The registry consisted of 16 TAVR centers (n = 7,303). Outcomes of patients with ≥ moderate versus lesser grade MR after TAVR were compared. RESULTS In 1,983 (27.2%) patients, baseline MR grade was ≥ moderate. MR regressed in 874 (44.1%) patients and persisted in 1,109 (55.9%) after TAVR. Four-year mortality was higher for those with MR persistence, but not for those with MR regression after TAVR, compared with nonsignificant baseline MR (43.8% vs. 35.1% vs. 32.4%; hazard ratio [HR]: 1.38; p = 0.008; HR: 1.02; p = 0.383, respectively). New York Heart Association functional class III to IV after TAVR was more common in those with MR persistence vs. regression (14.4% vs. 3.9%; p < 0.001). In a propensity score-matched cohort (91 patients' pairs), with significant residual MR after TAVR who did or did not undergo staged mitral intervention, staged intervention was associated with a better functional class through 1 year of follow-up (82.4% vs. 33.3% New York Heart Association functional class I or II; p < 0.001), and a numerically lower 4-year mortality, which was not statistically significant (64.6% vs. 37.5%; HR: 1.66; p = 0.097). CONCLUSIONS Risk stratification based on improvement in MR and symptoms after TAVR can identify patients at increased mortality risk after TAVR. These patients may benefit from a staged transcatheter mitral intervention, but this requires further proof from future studies. (Transcatheter Treatment for Combined Aortic and Mitral Valve Disease. The Aortic+Mitral TRAnsCatheter [AMTRAC] Valve Registry [AMTRAC]; NCT04031274).
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Affiliation(s)
- Guy Witberg
- Department of Cardiology, Rabin Medical Center, Petach Tikva, Israel; Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
| | - Pablo Codner
- Department of Cardiology, Rabin Medical Center, Petach Tikva, Israel; Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Uri Landes
- Department of Cardiology, Rabin Medical Center, Petach Tikva, Israel; Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Shmuel Schwartzenberg
- Department of Cardiology, Rabin Medical Center, Petach Tikva, Israel; Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Marco Barbanti
- Division of Cardiology, University of Catania, Catania, Italy
| | - Roberto Valvo
- Division of Cardiology, University of Catania, Catania, Italy
| | - Ole De Backer
- The Heart Center, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Joris F Ooms
- Department of Cardiology, Thoraxcenter, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Fabian Islas
- Cardiovascular Institute, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria San Carlos, Madrid, Spain
| | - Luis Marroquin
- Cardiovascular Institute, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria San Carlos, Madrid, Spain
| | | | | | - Giulia Masiero
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padua Medical School, Padua, Italy
| | - Paul Werner
- Division of Cardiac Surgery, Medical University of Vienna, Vienna, Austria
| | - Xavier Armario
- Department of Cardiology, Galway University Hospital, National University of Ireland, Galway, Ireland
| | | | - Dabit Arzamendi
- Hospital de Sant Creu i Sant Pau Barcelona, Barcelona, Spain
| | - Sandra Santos-Martinez
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | | | - Jose A Baz
- Servicio de Cardiología, Hospital Álvaro Cunqueiro, Vigo, Spain
| | - Klemen Steblovnik
- Department of Cardiology, University Medical Centre, Ljubljana, Slovenia
| | - Victor Mauri
- Department of Cardiology, Heart Centre, Faculty of Medicine, University of Cologne, Germany
| | - Matti Adam
- Department of Cardiology, Heart Centre, Faculty of Medicine, University of Cologne, Germany
| | - Ilan Merdler
- Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel; Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel
| | - Manuel Hein
- Department of Cardiology and Angiology II, University Heart Center Freiburg-Bad Krozingen, Bad Krozingen, Germany
| | - Philipp Ruile
- Department of Cardiology and Angiology II, University Heart Center Freiburg-Bad Krozingen, Bad Krozingen, Germany
| | - Carmelo Grasso
- Division of Cardiology, University of Catania, Catania, Italy
| | - Luca Branca
- Cardiovascular Department, Spedali Civili, Brescia, Italy
| | | | | | - Ignacio J Amat-Santos
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | - Darren Mylotte
- Department of Cardiology, Galway University Hospital, National University of Ireland, Galway, Ireland
| | - Martin Andreas
- Division of Cardiac Surgery, Medical University of Vienna, Vienna, Austria
| | - Matjaz Bunc
- Department of Cardiology, University Medical Centre, Ljubljana, Slovenia
| | - Giuseppe Tarantini
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padua Medical School, Padua, Italy
| | | | - Luis Nombela-Franco
- Cardiovascular Institute, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria San Carlos, Madrid, Spain
| | - Lars Søndergaard
- The Heart Center, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Nicolas M Van Mieghem
- Department of Cardiology, Thoraxcenter, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Ariel Finkelstein
- Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel; Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel
| | - Ran Kornowski
- Department of Cardiology, Rabin Medical Center, Petach Tikva, Israel; Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
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Loureiro-Ga M, Veiga C, Fdez-Manin G, Salvadores PJ, Jimenez VA, Baz JA, Iniguez A. 500.09 SimulTAVI - Personalized Medicine: Predicting Device Behaviour and Possible Outcomes of a TAVI by Using Image Processing and Numerical Simulation Techniques. JACC Cardiovasc Interv 2019. [DOI: 10.1016/j.jcin.2019.01.151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Loureiro Garcia M, Viega C, Fdez-Manin G, Jimenez VA, Juan Salvadores P, Baz JA, Iniguez A. P6224Hemodynamics of the left coronary artery after TAVI procedure: a numerical simulation analysis. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy566.p6224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- M Loureiro Garcia
- Alvaro Cunqueiro Hospital - Galicia Sur Health Research Institute (IIS Galicia Sur). SERGAS-UVIGO, Cardiology.
- University of Vigo, Applied Mathematics II Department, Vigo, Spain
| | - C Viega
- Alvaro Cunqueiro Hospital - Galicia Sur Health Research Institute (IIS Galicia Sur). SERGAS-UVIGO., Cardiology, Vigo, Spain
| | - G Fdez-Manin
- University of Vigo, Applied Mathematics II Department, Vigo, Spain
| | - V A Jimenez
- Alvaro Cunqueiro Hospital - Galicia Sur Health Research Institute (IIS Galicia Sur). SERGAS-UVIGO., Cardiology, Vigo, Spain
| | - P Juan Salvadores
- Alvaro Cunqueiro Hospital - Galicia Sur Health Research Institute (IIS Galicia Sur). SERGAS-UVIGO., Cardiology, Vigo, Spain
| | - J A Baz
- Alvaro Cunqueiro Hospital - Galicia Sur Health Research Institute (IIS Galicia Sur). SERGAS-UVIGO., Cardiology, Vigo, Spain
| | - A Iniguez
- Alvaro Cunqueiro Hospital - Galicia Sur Health Research Institute (IIS Galicia Sur). SERGAS-UVIGO., Cardiology, Vigo, Spain
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de La Torre Hernandez JM, Gomez Hospital JA, Baz JA, Brugaletta S, Perez de Prado A, Linares JA, Lopez Palop R, Cid B, Garcia Camarero T, Diego A, Gutierrez H, Fernandez Diaz JA, Sanchis J, Alfonso F, Blanco R, Botas J, Navarro Cuartero J, Moreu J, Bosa F, Vegas JM, Elizaga J, Arrebola AL, Hernandez F, Salvatella N, Monteagudo M, Gomez Jaume A, Carrillo X, Martin Reyes R, Lozano F, Rumoroso JR, Andraka L, Dominguez AJ. Multivessel disease in patients over 75years old with ST elevated myocardial infarction. Current management strategies and related clinical outcomes in the ESTROFA MI+75 nation-wide registry. Cardiovasc Revasc Med 2018; 19:580-588. [PMID: 29306670 DOI: 10.1016/j.carrev.2017.12.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2017] [Revised: 12/03/2017] [Accepted: 12/05/2017] [Indexed: 11/16/2022]
Abstract
BACKGROUND In elderly patients with ST elevated myocardial infarction (STEMI) and multivessel disease (MVD the outcomes related with different revascularization strategies are not well known. METHODS Subgroup-analysis of a nation-wide registry of primary angioplasty in the elderly (ESTROFA MI+75) with 3576 patients over 75years old from 31 centers. Patients with MVD were analyzed to describe treatment approaches and 2years outcomes. RESULTS Of 1830 (51%) with MVD, 847 (46%) underwent multivessel revascularization either in acute (51%), staged (44%) or both procedures (5%). Patients with previous myocardial infarction and those receiving drug-eluting stents or IIb-IIIa inhibitors were more prone to be revascularized, whereas older patients, females and those with Killip III-IV, renal failure and higher ejection fraction were less likely. Survival free of cardiac death and infarction at 2years was better for those undergoing multivessel PCI (85.8% vs. 80.4%, p<0.0008), regardless of Killip class. Multivessel PCI was protective of cardiac death and infarction (HR 0.60, 95% CI 0.40-0.89; p=0.011). Complete revascularization made no difference in outcomes among those patients undergoing multivessel PCI. The best prognosis corresponded to those undergoing multivessel PCI in staged procedures (p<0.001). A propensity score matching analysis (514 patients in each group) yielded similar results. CONCLUSIONS In elderly patients with STEMI and MVD, multivessel PCI was related with better outcomes especially after staged procedures. Among those undergoing multivessel PCI, anatomically defined completeness of revascularization had not prognostic influence. SUMMARY We sought to investigate the revascularization strategies applied and their prognostic implications in patients aged over 75years with ST elevated myocardial infarction showing multivessel disease. Of 1830 patients, 847 (46%) underwent multivessel PCI either in acute (51%), staged (44%) or both procedures (5%). Multivessel PCI was independent predictor of cardiac death and infarction with the best prognosis corresponding to those undergoing staged procedures.
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Affiliation(s)
| | | | - Jose A Baz
- Hospital de Vigo, Servicio de Cardiologia, Vigo, Spain
| | | | | | - Jose A Linares
- Hospital Clinico de Zaragoza, Servicio de Cardiologia, Zaragoza, Spain
| | | | - Belen Cid
- Hospital de Santiago de Compostela, Servicio de Cardiologia, Santiago de Compostela, Spain
| | | | - Alejandro Diego
- Hospital Clinico de Salamanca, Servicio de Cardiologia, Salamanca, Spain
| | - Hipolito Gutierrez
- Hospital Clinico de Valladolid, Servicio de Cardiologia, Valladolid, Spain
| | | | - Juan Sanchis
- Hospital Clinico de Valencia, Servicio de Cardiologia, Valencia, Spain
| | | | - Roberto Blanco
- Hospital de Cruces, Bilbao, Servicio de Cardiologia, Spain
| | - Javier Botas
- Hospital de Alcorcon, Servicio de Cardiologia, Alcorcon, Spain
| | | | - Jose Moreu
- Hospital Virgen de la Salud, Servicio de Cardiologia, Toledo, Spain
| | - Francisco Bosa
- Hospital Clinico de Tenerife, Servicio de Cardiologia, Santa Cruz de Tenerife, Spain
| | - Jose M Vegas
- Hospital de Cabueñes, Servicio de Cardiologia, Gijon, Spain
| | - Jaime Elizaga
- Hospital Gregorio Marañon, Servicio de Cardiologia, Madrid, Spain
| | | | | | - Neus Salvatella
- Hospital del Mar, Servicio de Cardiología, Grup de Recerca Biomèdica en Malalties del Cor, IMIM (Hospital del Mar Reseach Institute), Barcelona, Spain
| | | | | | - Xavier Carrillo
- Hospital Germans Trias i Pujol, Servicio de Cardiologia, Badalona, Spain
| | | | - Fernando Lozano
- Hospital de Ciudad Real, Servicio de Cardiologia, Ciudad Real, Spain
| | - Jose R Rumoroso
- Hospital de Galdacano, Servicio de Cardiologia, Bilbao, Spain
| | - Leire Andraka
- Hospital de Basurto, Servicio de Cardiologia, Bilbao, Spain
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Hernandez JMDLT, Hospital JAG, Brugaletta S, Baz JA, de Prado AP, Palop RL, Cid B, Camarero TG, Diego A, Gimeno F, Diaz JAF, Sanchis J, Alfonso F, Blanco R, Botas J, Navarro J, Moreu J, Bosa F, Vegas JM, Elizaga J, Arrebola AL, Arroyo JRR, Linares JA, Hernandez F, Salvatella N. A NEW PROGNOSIS SCORE TO PREDICT MORTALITY IN PATIENTS OVER 75 YEARS OLD UNDERGOING PRIMARY ANGIOPLASTY IN CARDIOGENIC SHOCK. J Am Coll Cardiol 2017. [DOI: 10.1016/s0735-1097(17)34667-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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de Belder A, de la Torre Hernandez JM, Lopez-Palop R, O'Kane P, Hernandez Hernandez F, Strange J, Gimeno F, Cotton J, Diaz Fernandez JF, Carrillo Saez P, Thomas M, Pinar E, Curzen N, Baz JA, Cooter N, Lozano I, Skipper N, Robinson D, Hildick-Smith D. A Prospective Randomized Trial of Everolimus-Eluting Stents Versus Bare-Metal Stents in Octogenarians. J Am Coll Cardiol 2014; 63:1371-5. [PMID: 24216285 DOI: 10.1016/j.jacc.2013.10.053] [Citation(s) in RCA: 76] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2013] [Revised: 10/01/2013] [Accepted: 10/08/2013] [Indexed: 11/26/2022]
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de Belder A, de la Torre Hernandez JM, Lopez-Palop R, O'Kane P, Hernandez Hernandez F, Strange J, Gimeno F, Cotton J, Diaz Fernandez JF, Carrillo Saez P, Thomas M, Pinar E, Curzen N, Baz JA, Cooter N, Lozano I, Skipper N, Robinson D, Hildick-Smith D. A prospective randomized trial of everolimus-eluting stents versus bare-metal stents in octogenarians: the XIMA Trial (Xience or Vision Stents for the Management of Angina in the Elderly). J Am Coll Cardiol 2013. [PMID: 24216285 DOI: 10.1016/s0735-1097(13)61664-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVES The aim of this study was to determine whether drug-eluting stents (DES) are superior to bare-metal stents (BMS) in octogenarian patients with angina. BACKGROUND Patients ≥80 years of age frequently have complex coronary disease warranting DES but have a higher risk of bleeding from prolonged dual antiplatelet therapy. METHODS This multicenter randomized trial was conducted in 22 centers in the United Kingdom and Spain. Patients ≥80 years of age underwent stent placement for angina. The primary endpoint was a 1-year composite of death, myocardial infarction, cerebrovascular accident, target vessel revascularization, or major hemorrhage. RESULTS In total, 800 patients (83.5 ± 3.2 years of age) were randomized to BMS (n = 401) or DES (n = 399) for treatment of stable angina (32%) or acute coronary syndrome (68%). Procedural success did not differ between groups (97.7% for BMS vs. 95.4% for DES; p = 0.07). Thirty-eight percent of patients had ≥2-vessel percutaneous coronary intervention, and 66% underwent complete revascularization. Patients who received BMS had shorter stent implants (24.0 ± 13.4 mm vs. 26.6 ± 14.3 mm; p = 0.01). Rates of dual antiplatelet therapy at 1 year were 32.2% for patients in the BMS group and 94.0% for patients in the DES group. The primary endpoint occurred in 18.7% of patients in the BMS group versus 14.3% of patients in the DES group (p = 0.09). There was no difference in death (7.2% vs. 8.5%; p = 0.50), major hemorrhage (1.7% vs. 2.3%; p = 0.61), or cerebrovascular accident (1.2% vs. 1.5%; p = 0.77). Myocardial infarction (8.7% vs. 4.3%; p = 0.01) and target vessel revascularization (7.0% vs. 2.0%; p = 0.001) occurred more often in patients in the BMS group. CONCLUSIONS BMS and DES offer good clinical outcomes in this age group. DES were associated with a lower incidence of myocardial infarction and target vessel revascularization without increased incidence of major hemorrhage. (Xience or Vision Stent-Management of Angina in the Elderly [XIMA]; ISRCTN92243650).
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Affiliation(s)
- Adam de Belder
- Brighton and Sussex University Hospitals National Health Service Trust, Brighton, England.
| | | | | | - Peter O'Kane
- Royal Bournemouth Hospital, Bournemouth, England
| | | | | | | | - James Cotton
- Royal Wolverhampton Hospital, Wolverhampton, England
| | | | | | | | | | - Nick Curzen
- Southampton University Hospitals National Health Service Trust, Southampton, England
| | | | - Nina Cooter
- Brighton and Sussex University Hospitals National Health Service Trust, Brighton, England
| | | | - Nicola Skipper
- Brighton and Sussex University Hospitals National Health Service Trust, Brighton, England
| | - Derek Robinson
- Department of Mathematics, University of Sussex, East Sussex, England
| | - David Hildick-Smith
- Brighton and Sussex University Hospitals National Health Service Trust, Brighton, England
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de la Torre Hernández JM, Alfonso F, Gimeno F, Diarte JA, Lopez-Palop R, Pérez de Prado A, Rivero F, Sanchis J, Larman M, Diaz JF, Elizaga J, Moreiras JM, Gomez Jaume A, Hernández JM, Mauri J, Recalde AS, Bullones JA, Rumoroso JR, del Blanco BG, Baz JA, Bosa F, Botas J, Hernández F. Thrombosis of Second-Generation Drug-Eluting Stents in Real Practice. JACC Cardiovasc Interv 2010; 3:911-9. [DOI: 10.1016/j.jcin.2010.06.010] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2010] [Accepted: 06/11/2010] [Indexed: 10/19/2022]
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Ferreira-González I, Marsal JR, Ribera A, Permanyer-Miralda G, García-Del Blanco B, Martí G, Cascant P, Martín-Yuste V, Brugaletta S, Sabaté M, Alfonso F, Capote ML, De La Torre JM, Ruíz-Lera M, Sanmiguel D, Cárdenas M, Pujol B, Baz JA, Iñiguez A, Trillo R, González-Béjar O, Casanova J, Sánchez-Gila J, García-Dorado D. Background, incidence, and predictors of antiplatelet therapy discontinuation during the first year after drug-eluting stent implantation. Circulation 2010; 122:1017-25. [PMID: 20733100 DOI: 10.1161/circulationaha.110.938290] [Citation(s) in RCA: 88] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Predictors of antiplatelet therapy discontinuation (ATD) during the first year after drug-eluting stent implantation are poorly known. METHODS AND RESULTS This was a prospective study with 3-, 6-, 9-, and 12-month follow-up of patients receiving at least 1 drug-eluting stent between January and April 2008 in 29 hospitals. Individual- and hospital-level predictors of ATD were assessed by hierarchical-multinomial regression analysis. ATD could be assessed in 1622 candidates for follow-up (82.5%). A total of 234 patients (14.4%) interrupted at least 1 antiplatelet therapy drug, predominantly clopidogrel (n=182, 11.8%). Bleeding events or invasive procedures led to ATD in 109 patients. This was predicted by renal impairment (odds ratio [OR] 2.81, 95% confidence interval [CI] 1.48 to 5.34), prior major hemorrhage (OR 3.77, 95% CI 1.41 to 10.03), and peripheral arterial disease (OR 1.78, 95% CI 1.01 to 3.15). Medical decisions led to ATD in 70 patients; this was predicted by long-term use of anticoagulant therapy (OR 3.88, 95% CI 1.26 to 11.98), undergoing the procedure in a private hospital (OR 13.3, 95% CI 1.69 to 105), and not receiving instructions about medication (OR 2.8, 95% CI 1.23 to 6.36). Thirty-nine patients interrupted ATD on their own initiative, mainly immigrants (OR 3.78, 95% CI 1.2 to 11.98) and consumers of psychotropic drugs (OR 2.58, 95% CI 1.3 to 5.12). CONCLUSIONS ATD during the first year after drug-eluting stent implantation is based mainly on patient decision or a medical decision not associated with major bleeding events or major surgical procedures. Individual- and hospital-level variables are important to predict ATD.
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Affiliation(s)
- Ignacio Ferreira-González
- Epidemiology Unit, Cardiology Department, University Hospital Vall d'Hebron, Paseo Vall d'Hebron 119-129, Barcelona 08035, Spain.
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