MP49. Racial Disparities in Utilization and Outcomes of Transcatheter Edge-To-Edge Repair for Mitral Valve Regurgitation
Presented During: Moderated E-Posters
- Contact Me
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 access of racial minorities to a high-volume mitral valve transcatheter edge-to-edge repair (TEER) center. In addition, we analyzed five-year outcomes of these patients compared to white patients.
METHODS: This is a retrospective clinical study of prospectively collected patients. All consecutive patients undergoing TEER between March 2017 and October 2021 were included in the study and input on a hospital database. White and non-white race patients were compared for baseline demographics. A propensity-adjusted analysis was used to compare the two groups. Primary outcome was long-term incidence of all-cause death and major adverse cardiovascular and cerebrovascular events (MACCE).
RESULTS: A total of 171 patients were included in the study. After propensity-adjusted analysis 15 patients were included in the non-white race cohort and 155 patients in the white race cohort. Preoperatively, non-whites were younger (72.2 vs 79 years; p=0.01) than white patients. However, non-white presented with a higher incidence of pre-procedural cardiogenic shock (4 [26.7%] vs 8 [5.16%]; p=0.01) compared to white patients. In addition, non-white patients had lower albumin levels (3.15 [0.75] vs 3.73 [1.62]). and proBNP levels reached twice the levels of the ones of white patients (1125.4 vs 685.6; p=0.17), although this difference did not reach statistical significance.
Intraoperatively, there were no differences among groups. Postoperatively, non-white patients had a higher ventilation time (16.1 vs 10 hours; p=0.0007) and total LOS (9.8 vs 3.9 days; p=0.04) compared to white patients. Mean follow-up was 2.1-years. There were no differences among the two groups in term of hospital readmission rates. At 5-years follow-up, there were no differences in term of all-cause death (HR 1.4 [0.7, 2.8]; p=0.33), MACCE (HR 1.3 [0.4, 3.5]; p=0.67), stroke (HR 0.8 [0.1, 6.0]; p=0.81), repeat intervention (HR 0.8 [0.1, 6.4]), and pacemaker implantation (HR 0.7 [0.1, 5.5]; p=0.74) among the two groups.
CONCLUSIONS. Racial disparities persist in a high-volume center. Despite their younger age, racial minorities have higher incidence of cardiogenic shock, lower albumin levels and higher proBNP levels, indicating more advanced disease and heart failure compared to white patients, at time of hospitalization for TEER procedure. Further research is needed to better understand racial disparities in utilization and outcomes of TEER.
METHODS: This is a retrospective clinical study of prospectively collected patients. All consecutive patients undergoing TEER between March 2017 and October 2021 were included in the study and input on a hospital database. White and non-white race patients were compared for baseline demographics. A propensity-adjusted analysis was used to compare the two groups. Primary outcome was long-term incidence of all-cause death and major adverse cardiovascular and cerebrovascular events (MACCE).
RESULTS: A total of 171 patients were included in the study. After propensity-adjusted analysis 15 patients were included in the non-white race cohort and 155 patients in the white race cohort. Preoperatively, non-whites were younger (72.2 vs 79 years; p=0.01) than white patients. However, non-white presented with a higher incidence of pre-procedural cardiogenic shock (4 [26.7%] vs 8 [5.16%]; p=0.01) compared to white patients. In addition, non-white patients had lower albumin levels (3.15 [0.75] vs 3.73 [1.62]). and proBNP levels reached twice the levels of the ones of white patients (1125.4 vs 685.6; p=0.17), although this difference did not reach statistical significance.
Intraoperatively, there were no differences among groups. Postoperatively, non-white patients had a higher ventilation time (16.1 vs 10 hours; p=0.0007) and total LOS (9.8 vs 3.9 days; p=0.04) compared to white patients. Mean follow-up was 2.1-years. There were no differences among the two groups in term of hospital readmission rates. At 5-years follow-up, there were no differences in term of all-cause death (HR 1.4 [0.7, 2.8]; p=0.33), MACCE (HR 1.3 [0.4, 3.5]; p=0.67), stroke (HR 0.8 [0.1, 6.0]; p=0.81), repeat intervention (HR 0.8 [0.1, 6.4]), and pacemaker implantation (HR 0.7 [0.1, 5.5]; p=0.74) among the two groups.
CONCLUSIONS. Racial disparities persist in a high-volume center. Despite their younger age, racial minorities have higher incidence of cardiogenic shock, lower albumin levels and higher proBNP levels, indicating more advanced disease and heart failure compared to white patients, at time of hospitalization for TEER procedure. Further research is needed to better understand racial disparities in utilization and outcomes of TEER.