MP42. Outcomes of Dual Antiplatelet Therapy After Transcatheter Edge-To-Edge Repair for Mitral Valve Regurgitation
Presented During: Moderated E-Posters
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I did my medical school in Firenze, Italy.
I did My residency in Siena, Italy.
I did a three year clinical fellowship in Toronto, Canada.
I did a PhD at CARIM Maastricht University.
I am an Associate Professor at Lankenau Institute for Medical Research.
Thursday, May 4, 2023: 6:30 PM - Saturday, May 6, 2023: 2:29 AM
New York Hilton Midtown
Room: Grand Ballroom Foyer
Description
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.