Trends, Predictors, and Outcomes of Bleeding Complications After Mitral Transcatheter Edge-to-Edge Repair: TVT Registry Insights.

Autor:	Singh N; Division of Cardiology, New York Presbyterian-Weill Cornell Medical Center, New York, New York, USA., Cohen DJ; Cardiovascular Research Foundation, New York, New York, USA; St. Francis Hospital and Heart Center, Roslyn, New York, USA., Shah MA; Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina, USA., Kosinski AS; Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina, USA., Brothers L; Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina, USA., Vemulapalli S; Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina, USA., Elmariah S; Division of Cardiology, University of California-San Francisco, San Francisco, California, USA. Electronic address: Sammy.Elmariah@ucsf.edu.
Jazyk:	angličtina
Zdroj:	JACC. Cardiovascular interventions [JACC Cardiovasc Interv] 2024 Oct 28; Vol. 17 (20), pp. 2337-2349.
DOI:	10.1016/j.jcin.2024.09.035
Abstrakt:	Background: Bleeding events after arterial transcatheter procedures are associated with increased morbidity and mortality. The frequency and clinical implications of bleeding after mitral transcatheter edge-to-edge repair (M-TEER) have not been well-studied. Objectives: The authors sought to explore the association of in-hospital bleeding events after M-TEER with patient outcomes. Methods: Patients undergoing M-TEER who were included in the TVT (Transcatheter Valve Therapy) Registry between 2013 and 2022 were included. Rates of the primary endpoint, the composite of death or hospital readmission at 30 days, were compared between patients who experienced in-hospital major or life-threatening bleeding vs those without bleeding. Secondary analyses examined the association between in-hospital bleeding and death or readmission at 1 year, as well as independent predictors of major in-hospital bleeding. Results: Over the study period, in-hospital major bleeding occurred in 1,205 (2.3%) of 51,533 patients. Rates of bleeding decreased over time (from 7.1% in 2013 to 2.0% in 2021; P < 0.001). In-hospital bleeding was associated with increased rates of death or readmission at both 30 days (adjusted OR: 2.15 [95% CI: 1.81-2.54]; P < 0.0001) and 1 year (adjusted HR: 1.43 [95% CI: 1.27-1.60]; P < 0.0001). The strongest correlates of in-hospital bleeding included female sex, prior percutaneous coronary intervention, baseline hemoglobin, greater procedure acuity, and longer procedure duration. Conclusions: Bleeding after M-TEER is associated with increased risk of subsequent death and hospital readmission. Although reductions in bleeding complications over time are encouraging, continued efforts are needed to further mitigate hemorrhagic complications of M-TEER. Competing Interests: Funding Support and Author Disclosures This research was supported by the American College of Cardiology’s National Cardiovascular Data Registry (NCDR). The views expressed in this paper represent those of the author(s), and do not necessarily represent the official views of the NCDR or its associated professional societies identified at CVQuality.ACC.org/NCDR. Dr Cohen has received institutional research grants from Edwards Lifesciences, Boston Scientific, Abbott, and JC Medical; and consulting income from Edwards Lifesciences, Boston Scientific, Abbott, and Medtronic. Dr Vemulapalli has received grants/contracts from the American College of Cardiology, Society of Thoracic Surgeons, National Institutes of Health, Cytokinetics, Abbott Vascular, and the Food and Drug Administration; and consulting/honoraria from Medtronic, Veralox Therapeutics, American College of Physicians, AstraZeneca, Boehringer Ingelheim, Cytokinetics, and Icon. Dr Elmariah has been a consultant for and has received institutional research grants from Edwards Lifesciences and Medtronic. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose. (Copyright © 2024 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.)
Databáze:	MEDLINE
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