Outcomes of Dual Antiplatelet therapy after transcatheter edge-to-edge repair for mitral valve regurgitation.
Presented During:
Thursday, May 4, 2023: 6:30PM - Saturday, May 6, 2023: 2:29AM
New York Hilton Midtown
Posted Room Name:
Grand Ballroom Foyer
Abstract No:
MP042
Submission Type:
Abstract Submission
Authors:
Aleksander Dokollari (1), Serge Sicouri (2), John Malin (2), Sandra Abramson (1), Eric M Gnall (3), Gianluca Torregrossa (4), Roberto Rodriguez (1), Scott Goldman MD (1), William A Gray (1), Basel Ramlawi (5)
Institutions:
(1) Lankenau Medical Center, Wynnewood, PA, (2) Lankenau Institute for Medical Research, Wynnewood, PA, (3) Department of Cardiology, Wynnewood, PA, (4) Lankenau Medical Center, New York, NY, (5) Lankenau Heart Institute, Wynnewood, PA
Submitting Author:
Aleksander Dokollari
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Lankenau Medical Center
Lankenau Medical Center
Co-Author(s):
Serge Sicouri
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Lankenau Institute for Medical Research
Lankenau Institute for Medical Research
John Malin
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Lankenau Institute for Medical Research
Lankenau Institute for Medical Research
Sandra Abramson
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Lankenau Medical Center
Lankenau Medical Center
Eric M Gnall
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Department of Cardiology
Department of Cardiology
Gianluca Torregrossa
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Lankenau Medical Center
Lankenau Medical Center
Roberto Rodriguez
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Lankenau Medical Center
Lankenau Medical Center
*Scott Goldman MD
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Lankenau Medical Center
Lankenau Medical Center
William A Gray
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Lankenau Medical Center
Lankenau Medical Center
*Basel Ramlawi
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Lankenau Heart Institute
Lankenau Heart Institute
Presenting Author:
Aleksander Dokollari
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Abstract:
OBJECTIVE: To analyze the outcomes of dual antiplatelet (DAPT) therapy with aspirin (ASA) and clopidogrel after mitral valve repair (MVR) with transcatheter edge-to-edge repair (TEER).
METHODS: All consecutive patients undergoing TEER between March 2017 and October 2021 were included in the study. DAPT vs. non-DAPT cohorts were compared for baseline demographics and pre-operative characteristics. A propensity-adjusted analysis was used to compare the two groups. Matched samples were compared with McNemar's test and marginal homogeneity tests for categorical variables and matched paired t-tests and signed rank tests for continuous variables. Primary outcomes were long-term incidence of cardiac death and all-cause death. To illustrate the effect of DAPT therapy on long-term prognosis, Kaplan–Meier cumulative survival curves were constructed. After propensity adjustment, all baseline characteristics (including oral anticoagulant usage, age, risk etc.) were similar between the two groups.
RESULTS: A total of 171 patients were included in the study. After propensity-adjusted analysis 65 patients were included in the DAPT cohort and 104 patients were included in the non-DAPT cohort. Preoperatively, the DAPT cohort had a lower STS-PROM score (5% [±6%] vs 8% [±9%]; p=0.005), a lower proBNP level (562 [±844] vs 831 [±892]; p=0.02), a lower incidence of atrial fibrillation (19 [±29.2%] vs 97 [±93.3%]; p<0.0001), and a higher mean ejection fraction (56.2% [±16.1%] vs 50.6% [±15.3%]; p=0.02) compared to the non-DAPT cohort. Intraoperatively, there were no differences among groups. Postoperatively, DAPT cohort had a lower use of oral anticoagulants including warfarin (2 [3.1%] vs 27 [25.9%]; p<0.0001), apixaban (2 [3.1%] vs 47 [45.2%]; p<0.0001), rivaroxaban (1 [1.54%] vs 20 [19.2%]; p=0.0004). Mean follow-up was 2.2 years. At 5-years follow-up, cardiac mortality was significantly higher in the non-DAPT cohort (HR 0.4 [0.2, 1.1]; p=0.018). All other outcomes including all-cause death (p=0.139), myocardial infarction (p=0.13), stroke (p=0.4), MACCE (p=0.1), repeat intervention (p=0.43), and new pacemaker implantation (p=0.5) did not differ among groups.
CONCLUSIONS. DAPT therapy had a lower incidence of cardiac death. Secondary prevention with DAPT in patients undergoing TEER for MR may play a role in reducing the incidence of cardiac mortality and warrants prospective randomized controlled trial evaluation.
METHODS: All consecutive patients undergoing TEER between March 2017 and October 2021 were included in the study. DAPT vs. non-DAPT cohorts were compared for baseline demographics and pre-operative characteristics. A propensity-adjusted analysis was used to compare the two groups. Matched samples were compared with McNemar's test and marginal homogeneity tests for categorical variables and matched paired t-tests and signed rank tests for continuous variables. Primary outcomes were long-term incidence of cardiac death and all-cause death. To illustrate the effect of DAPT therapy on long-term prognosis, Kaplan–Meier cumulative survival curves were constructed. After propensity adjustment, all baseline characteristics (including oral anticoagulant usage, age, risk etc.) were similar between the two groups.
RESULTS: A total of 171 patients were included in the study. After propensity-adjusted analysis 65 patients were included in the DAPT cohort and 104 patients were included in the non-DAPT cohort. Preoperatively, the DAPT cohort had a lower STS-PROM score (5% [±6%] vs 8% [±9%]; p=0.005), a lower proBNP level (562 [±844] vs 831 [±892]; p=0.02), a lower incidence of atrial fibrillation (19 [±29.2%] vs 97 [±93.3%]; p<0.0001), and a higher mean ejection fraction (56.2% [±16.1%] vs 50.6% [±15.3%]; p=0.02) compared to the non-DAPT cohort. Intraoperatively, there were no differences among groups. Postoperatively, DAPT cohort had a lower use of oral anticoagulants including warfarin (2 [3.1%] vs 27 [25.9%]; p<0.0001), apixaban (2 [3.1%] vs 47 [45.2%]; p<0.0001), rivaroxaban (1 [1.54%] vs 20 [19.2%]; p=0.0004). Mean follow-up was 2.2 years. At 5-years follow-up, cardiac mortality was significantly higher in the non-DAPT cohort (HR 0.4 [0.2, 1.1]; p=0.018). All other outcomes including all-cause death (p=0.139), myocardial infarction (p=0.13), stroke (p=0.4), MACCE (p=0.1), repeat intervention (p=0.43), and new pacemaker implantation (p=0.5) did not differ among groups.
CONCLUSIONS. DAPT therapy had a lower incidence of cardiac death. Secondary prevention with DAPT in patients undergoing TEER for MR may play a role in reducing the incidence of cardiac mortality and warrants prospective randomized controlled trial evaluation.
Mitral Conclave:
Transcatheter Mitral Valve Therapies
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