Antithrombotic Treatment and Its Association with Outcome in a Multicenter Cohort of Transcatheter Edge-to-Edge Mitral Valve Repair Patients
Abstract
:1. Introduction
2. Methods
3. Results
3.1. Pre- and Postprocedural Antithrombotic Therapy and Prescription Duration
3.2. Trends in Postprocedural Antithrombotic Therapy during the Study Period in Patients with an Indication for Oral Anticoagulation
3.3. Trends in VKA and NOAC Use during the Study Period
3.4. Association of Antithrombotic Therapy and Outcome
4. Discussion
5. Limitations
6. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Overall (n = 609) | No APT (n = 11) | SAPT (n = 17) | DAPT (n = 132) | OAC Mono (n = 146) | OAC + SAPT (n = 248) | OAC + DAPT (n = 55) | p-Value # | |
---|---|---|---|---|---|---|---|---|
Age (years) | 78.1 ± 8 | 72.5 ± 11 | 74.3 ± 9.8 | 78.5 ± 7.6 | 78.9 ± 7.5 | 78.4 ± 8 | 76.2 ± 7.9 | 0.2 |
Male sex | 61% (373) | 72.7% (8) | 64.7% (11) | 53.8% (71) | 58.9% (86) | 63.3% (157) | 63% (40) | 0.08 |
euroSCORE II * | 17.0 (21.7) | 41.0 (43.8) | 20.1 (15) | 17.0 (20.6) | 19.1 (23.1) | 13.0 (20.7) | 22.7 (24.3) | <0.0001 |
STS Risk Score * | 7.0 (8.6) | 18.8 (35.3) | 7.3 (5.7) | 7.0 (7.4) | 6.6 (9.8) | 6.7 (7.9) | 8.4 (9.9) | 0.3 |
NYHA class I NYHA class II NYHA class III NYHA class IV | 0.2% (1) 4% (24) 71.8% (437) 24.1% (147) | 0% (0) 9.1% (1) 27.3% (3)63.6% (7) | 0% (0) 0% (0) 70.6% (12) 29.4% (5) | 0% (0) 6.1% (8) 73.5% (97) 20.5% (27) | 0% (0) 2.7% (4) 76.7% (112) 20.5% (61) | 0.4% (1) 3.2% (8) 71.8% (178) 24.6% (61) | 0% (0) 7.4% (2) 59.3% (16) 33.3% (9) | 0.6 |
COPD | 21.2% (129) | 27.3% (3) | 35.3% (6) | 24.2% (32) | 20.5% (32) | 19.4% (48) | 18.2% (10) | 0.7 |
CAD | 67.2% (409) | 81.8% (9) | 76.5% (13) | 78.8% (104) | 54.8% (80) | 65.3% (162) | 74.5% (41) | <0.0001 |
Prior CAB-OP | 27.1% (165) | 18.2% (2) | 52.9% (9) | 34.1% (45) | 21.2% (31) | 25.8% (64) | 25.5% (14) | 0.1 |
Prior PCI | 58.8% (358) | 81.8% (9) | 70.6% (12) | 66.7% (88) | 51.4% (75) | 57.7% (143) | 56.4% (31) | 0.07 |
Diabetes mellitus | 33% (201) | 27.3% (3) | 35.3% (6) | 34.8% (46) | 31.5% (46) | 31.5% (78) | 40% (22) | 0.6 |
Arterial hypertension | 82.8% (504) | 36.4% (4) | 82.4% (14) | 80.3% (106) | 81.5% (119) | 87.1% (216) | 81.8% (45) | 0.3 |
Prior Stroke | 10.8% (66) | 0% (0) | 5.9% (1) | 8.3% (11) | 9.6% (14) | 12.5% (31) | 16.4% (9) | 0.3 |
Pre-existing ICD | 25.5% (155) | 9.1% (1) | 41.2% (7) | 20.5% (27) | 19.9% (29) | 27% (67) | 43.6% (24) | 0.003 |
Pre-existing CRT | 13.3% (81) | 0% (0) | 11.8% (2) | 11.4% (15) | 12.3% (18) | 17.7% (44) | 3.6% (2) | 0.03 |
Atrial fibrillation | 75.4% (459) | 81.8% (9) | 35.3% (6) | 17.4% (23) | 92.5% (135) | 94.4% (234) | 94.5% (52) | <0.0001 |
GFR (mL/Min) † | 48.3 ± 21.6 | 55 ± 30 | 58.2 ± 21 | 50.6 ± 23 | 47.9 ± 21 | 46 ± 20.8 | 47.7 ± 20.7 | 0.4 |
NT-proBNP (ng/L) * | 2620 (4863) | 12325 (16208) | 2265 (4752) | 2479 (3768) | 2992 (4515) | 2455 (5028) | 2536 (6767) | 0.3 |
LVEF (%) † | 40.3 ± 14.1 | 30 ± 10.8 | 36.5 ± 14.6 | 39 ± 14 | 42.8 ± 14.4 | 41 ± 14 | 35.9 ± 13.3 | <0.001 |
TR grade III | 18.9% (115) | 18.2% (2) | 23.5% (4) | 12.9% (17) | 17.8% (26) | 21% (52) | 25.5% (14) | 0.1 |
Degenerative MR etiology Functional MR etiology Mixed MR etiology | 25.9% (158) 62.4% (380) 11.7% (71) | 0% (0) 100% (11) 0% (0) | 11.8% (2) 76.5% (13) 11.8% (2) | 23.5% (31) 64.4% (85) 12.1% (16) | 34.9% (51) 58.2% (85) 6.8% (10) | 26.6% (66) 58.1% (144) 15.3% (38) | 14.5% (8) 76.4% (42) 9.1% (5) | 0.01 |
Number of clips implanted † | 1.6 ± 0.6 | 2.2 ± 0.6 | 1.6 ± 0.7 | 1.5 ± 0.6 | 1.7 ± 0.7 | 1.6 ± 0.6 | 1.6 ± 0.6 | 0.053 |
Periprocedual MR reduction † (Carpentier grade) | 2.1 ± 0.6 | 1.9 ± 0.7 | 1.9 ± 0.9 | ∆2.1 ± 0.6 | 2.2 ± 0.6 | ∆2 ± 0.6 | ∆2.1 ± 0.6 | 0.02 |
Heart Failure Medication | ||||||||
ACE-/AT1 Inhibitors | 74.6% (454) | 27.3% (3) | 70.6% (12) | 74.2% (98) | 71.9% (105) | 79.4% (197) | 70.9% (39) | 0.3 |
ARN Inhibitor | 8.9% (54) | 0% (0) | 17.6% (3) | 5.3% (7) | 11.6% (17) | 9.3% (23) | 7.3% (4) | 0.3 |
Beta Blockers | 88.3% (538) | 45.5% (5) | 88.2% (15) | 87.9% (116) | 88.4% (129) | 90.3% (224) | 89.1% (49) | 0.9 |
Loop diuretics | 89.5% (545) | 36.4% (4) | 88.2% (15) | 88.6% (117) | 91.8% (134) | 91.5% (227) | 87.3% (48) | 0.6 |
Thiazid diuretics | 21.8% (133) | 0% (0) | 23.5% (4) | 22.7% (30) | 18.5% (27) | 25.8% (64) | 14.5% (8) | 0.2 |
Aldosteron antagonists | 49.6% (302) | 27.3% (3) | 58.8% (10) | 50% (66) | 47.3% (69) | 52.8% (131) | 41.8% (23) | 0.4 |
Postprocedural Antithrombotic Medication | ||||||||
ASA | 33.0% (201/609) | 0% (0) | 82.4% (14/17) | 100% (132/132) | 0% (0) | 0% (0) | 100% (55/55) | - |
Clopidogrel | 71.9% (438/609) | 0% (0) | 17.6% (3/17) | 100% (132/132) | 0% (0) | 100% (248/248) | 100% (55/55) | - |
Other antiplatelets | 0% (0/0) | 0% (0) | 0% (0) | 0% (0) | 0% (0) | 0% (0) | 0% (0) | - |
VKA | 38.4% (234/609) | 0% (0) | 0% (0) | 0% (0) | 58.9% (86/146) | 43.5% (108/248) | 72.7% (40/55) | - |
NOAC | 35.3% (215/609) | 0% (0) | 0% (0) | 0% (0) | 41.1% (60/146) | 56.5% (140/248) | 27.3% (15/55) | - |
Overall (n = 609) | No APT (n = 11) | SAPT (n = 17) | DAPT (n = 132) | OAC Mono (n = 146) | OAC + SAPT (n = 248) | OAC + DAPT (n = 55) | p-Value * | |
---|---|---|---|---|---|---|---|---|
Overall-MACCE Cerebral/systemic thromboembolic event Bleeding requiring intervention In-hospital death from cardiovasc. cause | 4.6% (28) 0.5% (3) 2.6% (16) 1.97% (12) | 36.4% (4) 9.1% (1) 9.1% (1) 27.3% (3) | 0% (0) 0% (0) 0% (0) 0% (0) | 6.1% (8) 0% (0) 3.8% (5) 2.3% (3) | 3.4% (5) 0.7% (1) 2.1% (3) 1.4% (3) | 4% (10) 0.4% (1) 2.4% (6) 1.6% (4) | 1.8% (1) 0% (0) 1.8% (1) 0% (0) | 0.6 1 0.8 0.9 |
In-hospital death from any cause | 3.94% (24) | 63.6% (7) | 11.8% (2) | 3% (4) | 2.7% (4) | 2% (5) | 3.6% (2) | 0.8 |
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Waechter, C.; Ausbuettel, F.; Chatzis, G.; Cheko, J.; Fischer, D.; Nef, H.; Barth, S.; Halbfass, P.; Deneke, T.; Mueller, J.; et al. Antithrombotic Treatment and Its Association with Outcome in a Multicenter Cohort of Transcatheter Edge-to-Edge Mitral Valve Repair Patients. J. Cardiovasc. Dev. Dis. 2022, 9, 366. https://doi.org/10.3390/jcdd9110366
Waechter C, Ausbuettel F, Chatzis G, Cheko J, Fischer D, Nef H, Barth S, Halbfass P, Deneke T, Mueller J, et al. Antithrombotic Treatment and Its Association with Outcome in a Multicenter Cohort of Transcatheter Edge-to-Edge Mitral Valve Repair Patients. Journal of Cardiovascular Development and Disease. 2022; 9(11):366. https://doi.org/10.3390/jcdd9110366
Chicago/Turabian StyleWaechter, Christian, Felix Ausbuettel, Georgios Chatzis, Juan Cheko, Dieter Fischer, Holger Nef, Sebastian Barth, Philipp Halbfass, Thomas Deneke, Julian Mueller, and et al. 2022. "Antithrombotic Treatment and Its Association with Outcome in a Multicenter Cohort of Transcatheter Edge-to-Edge Mitral Valve Repair Patients" Journal of Cardiovascular Development and Disease 9, no. 11: 366. https://doi.org/10.3390/jcdd9110366