Subahi Ahmed, Munir Ahmad, Abubakar Hossam, Akintoye Emmanuel, Yassin Ahmed S, Adegbala Oluwole, Alraies Mohamed Chadi, Elder Mahir, Mohamad Tamam, Kaki Amir, Schreiber Theodore
Department of Internal Medicine, Wayne State University/Detroit Medical Center, Detroit, Michigan.
Department of Interventional Cardiology, Wayne State University/Detroit Medical Center, Detroit, Michigan.
J Interv Cardiol. 2018 Dec;31(6):925-931. doi: 10.1111/joic.12568. Epub 2018 Nov 19.
The concomitant presence of atrial fibrillation (AF) in the setting of Transcatheter Mitral Valve Repair (TMVR) represents a clinical challenge. Despite the high AF burden in patients presenting for the TMVR procedure, there are no studies that evaluate the impact of AF on in-hospital outcomes of TMVR in a nationally representative United States sample reflecting real practice. Therefore, we sought to study the outcomes of AF patients undergoing TMVR.
The study included 1026 patients from the National Inpatient Sample (NIS) registry. Patients (age ≥18 years) who had undergone TAVR as a primary procedure from 2011 to 2014 were included, using the ICD-9-CM diagnostic codes. We examined patient characteristics and in-hospital outcomes. To account for patient and hospital-level baseline differences, we performed propensity score-matched analysis. The prevalence of AF was approximately 56%. After adjusting for patient-level and hospital-level characteristics, there was no statistical difference regarding in-hospital mortality (odds ratio [OR] 0.72, 95%CI 0.29-1.80, P = 0.487), post-TMVR complications, length of stay (OR 1.15, 95%CI 0.97-1.38, P = 0.111), and cost of hospitalization (OR 1.04, 95%CI 0.94-1.14, P = 0.475) between the group with AF versus without AF. However, patients with AF were more likely to have non-routine hospital discharge (42.94% vs 35.48% P = 0.02).
AF is a frequently encountered arrhythmia among patients undergoing TMVR with MitraClip. However, TMVR can be performed safely in the vast majority of patients, irrespective of their baseline rhythm.
经导管二尖瓣修复术（TMVR）患者中合并存在心房颤动（AF）是一项临床挑战。尽管接受TMVR手术的患者房颤负担较高，但尚无研究在美国具有全国代表性的反映实际情况的样本中评估房颤对TMVR住院结局的影响。因此，我们试图研究接受TMVR的房颤患者的结局。
该研究纳入了来自国家住院样本（NIS）登记处的1026例患者。使用ICD-9-CM诊断代码，纳入2011年至2014年作为主要手术接受经导管主动脉瓣置换术（TAVR）的患者（年龄≥18岁）。我们检查了患者特征和住院结局。为了考虑患者和医院层面的基线差异进行倾向评分匹配分析。房颤的患病率约为56%。在调整患者层面和医院层面特征后，房颤组与非房颤组在住院死亡率（比值比[OR]0.72，95%可信区间0.29-1.80，P = 0.487）、TMVR术后并发症、住院时间（OR 1.15，95%可信区间0.97-1.38，P = 0.111）和住院费用（OR 1.04，95%可信区间0.94-1.14，P = 0.475）方面无统计学差异。然而，房颤患者更有可能非常规出院（42.94%对35.48%，P = 0.02）。
房颤是接受MitraClip TMVR治疗的患者中常见的心律失常。然而，绝大多数患者无论其基线心律如何，都可以安全地进行TMVR。
