经皮二尖瓣修复术（MitraClip）患者中既往存在冠状动脉疾病的影响。
Impact of preexisting coronary arterial disease in patients undergoing percutaneous mitral valve repair (MitraClip).
机构信息
Department of Internal Medicine, University of Missouri Hospital, Columbia, Missouri, USA.
Department of Cardiology, University of California San Diego, San Diego, California, USA.
出版信息
Catheter Cardiovasc Interv. 2021 Apr 1;97(5):919-924. doi: 10.1002/ccd.29404. Epub 2020 Nov 28.
INTRODUCTION
Percutaneous mitral valve repair with Mitraclip device has been approved for the treatment of symptomatic mitral valve regurgitation in patients deemed high surgical risk. It's unclear whether the presence of preexisting coronary arterial disease (CAD) affects the postprocedural outcomes of Mitraclip.
METHODS
The study population was extracted from the 2016 Nationwide Readmissions Data (NRD) using the International Classification of Diseases, Tenth Revision, Clinical Modifications/Procedure Coding System (ICD-10-CM/PCS) for Mitraclip, preexisting CAD, and postprocedural complications. Study primary endpoints included in-hospital all-cause mortality, cardiogenic shock, acute myocardial infarction (AMI), acute kidney injury (AKI), stroke, acute respiratory failure, length of hospital stay (LOS), and 30-day readmission rate.
RESULTS
A total of 2,539 discharges that had Mitraclip during the index hospitalization, 62.3% had history of preexisting CAD. Mean age was 78.5 years and 46.6% were female. Overall, the presence of preexisting CAD was associated with higher AMI (1.6 vs. 0.4%, p < .01), however, there was no significant differences in terms of in-hospital all-cause mortality (2.2 vs. 2.6%, p = .52), cardiogenic shock (3.4 vs. 4.1%, p = .39), AKI (14.7 vs. 13.6%, p = .43), stroke (0.9 vs. 0.5%, p = .31), acute respiratory failure (9.7 vs. 8.8%, p = .43), LOS (5.3 vs. 5.3 days, p = .85) or 30-day readmission rate (14.6 vs. 14.4%, p = .92). These results persisted after adjustment for baseline characteristics. The subgroup of CAD patients who received percutaneous coronary intervention (PCI) was associated with higher in-hospital mortality (22.5 vs. 2.0%, p < .01), cardiogenic shock (25.0 vs. 3.3%, p < .01), AMI (22.5 vs. 0.8%, p < .01), AKI (55.0 vs. 13.7%, p < .01), stroke (10.0 vs. 0.6%, p < .01), acute respiratory failure (45.0 vs. 8.8%, p < .01), and longer LOS (21.5 vs. 5.1 days, p < .01), however there was no significant difference in 30-day readmission rate (15.0 vs. 14.5%, p = .95).
CONCLUSIONS
Preexisting CAD was associated with higher in-hospital AMI post-Mitraclip but with comparable mortality and other morbidities. Patients who received PCI during the same index hospitalization had higher in-hospital mortality and morbidity.
简介
经皮二尖瓣修复术使用 Mitraclip 装置已被批准用于治疗被认为手术风险高的有症状的二尖瓣反流。目前尚不清楚是否存在预先存在的冠状动脉疾病（CAD）会影响 Mitraclip 后的手术结果。
方法
从 2016 年全国再入院数据（NRD）中提取研究人群，使用国际疾病分类第 10 次修订版临床修正/程序编码系统（ICD-10-CM/PCS）进行 Mitraclip、预先存在的 CAD 和术后并发症。研究的主要终点包括住院全因死亡率、心源性休克、急性心肌梗死（AMI）、急性肾损伤（AKI）、卒中和急性呼吸衰竭、住院时间（LOS）和 30 天再入院率。
结果
在索引住院期间共有 2539 例进行 Mitraclip 的出院患者，其中 62.3%有预先存在的 CAD 病史。平均年龄为 78.5 岁，46.6%为女性。总的来说，预先存在的 CAD 与更高的 AMI（1.6%比 0.4%，p<0.01）相关，但在住院全因死亡率方面无显著差异（2.2%比 2.6%，p=0.52）、心源性休克（3.4%比 4.1%，p=0.39）、AKI（14.7%比 13.6%，p=0.43）、卒（0.9%比 0.5%，p=0.31）、急性呼吸衰竭（9.7%比 8.8%，p=0.43）或 30 天再入院率（14.6%比 14.4%，p=0.92）。这些结果在调整基线特征后仍然存在。CAD 患者接受经皮冠状动脉介入治疗（PCI）的亚组与更高的住院死亡率（22.5%比 2.0%，p<0.01）、心源性休克（25.0%比 3.3%，p<0.01）、AMI（22.5%比 0.8%，p<0.01）、AKI（55.0%比 13.7%，p<0.01）、卒（10.0%比 0.6%，p<0.01）、急性呼吸衰竭（45.0%比 8.8%，p<0.01）和更长的 LOS（21.5 比 5.1 天，p<0.01）相关，但 30 天再入院率无显著差异（15.0%比 14.5%，p=0.95）。
结论
预先存在的 CAD 与 Mitraclip 后住院期间更高的 AMI 相关，但死亡率和其他发病率无差异。在同一索引住院期间接受 PCI 的患者有更高的住院死亡率和发病率。
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