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Incidence and prognostic implications of late bleeding events after percutaneous mitral valve repair

OBJECTIVES: MitraClip is an established therapy for patients with mitral regurgitation (MR) that are considered of high-risk or inoperable. However, late bleeding events (BE) after hospital discharge and their impact on prognosis in this cohort of patients have been poorly investigated. Our purpose...

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Autores principales: Benito-González, Tomás, Estévez-Loureiro, Rodrigo, de Prado, Armando Pérez, Minguito-Carazo, Carlos, del Castillo García, Samuel, Garrote-Coloma, Carmen, Iglesias-Gárriz, Ignacio, Alonso-Rodríguez, David, Cardona, Javier Gualis, Ramón, Carlos Cuellas, Benito, María López, Estévez, Julia Vidán, Fernández-Vázquez, Felipe
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Elsevier 2018
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6148729/
https://www.ncbi.nlm.nih.gov/pubmed/30255126
http://dx.doi.org/10.1016/j.ijcha.2018.09.004
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author Benito-González, Tomás
Estévez-Loureiro, Rodrigo
de Prado, Armando Pérez
Minguito-Carazo, Carlos
del Castillo García, Samuel
Garrote-Coloma, Carmen
Iglesias-Gárriz, Ignacio
Alonso-Rodríguez, David
Cardona, Javier Gualis
Ramón, Carlos Cuellas
Benito, María López
Estévez, Julia Vidán
Fernández-Vázquez, Felipe
author_facet Benito-González, Tomás
Estévez-Loureiro, Rodrigo
de Prado, Armando Pérez
Minguito-Carazo, Carlos
del Castillo García, Samuel
Garrote-Coloma, Carmen
Iglesias-Gárriz, Ignacio
Alonso-Rodríguez, David
Cardona, Javier Gualis
Ramón, Carlos Cuellas
Benito, María López
Estévez, Julia Vidán
Fernández-Vázquez, Felipe
author_sort Benito-González, Tomás
collection PubMed
description OBJECTIVES: MitraClip is an established therapy for patients with mitral regurgitation (MR) that are considered of high-risk or inoperable. However, late bleeding events (BE) after hospital discharge and their impact on prognosis in this cohort of patients have been poorly investigated. Our purpose is to address the incidence, related factors and clinical implications of BE after hospital discharge in patients treated with MitraClip. METHODS: Prospective registry of all consecutive patients (n = 80) who underwent MitraClip implantation in our Institution between June 2014 and December 2017. BE were defined according to MVARC definitions. A combined clinical end-point including admission for heart failure (HF) and all-cause mortality was established to analyze prognostic implications of BE. RESULTS: During a median follow up of 523.5 days, 41 BE were reported in 21 patients. Atrial fibrillation (AF, HR 4.54, CI95% 1.20–17.10) and combined antithrombotic therapy at discharge (HR 3.52, CI95% 1.03–11.34) were independently associated with BE. In the study period, 15 (18.8%) patients died, 20 (25%) were admitted for HF and 29 (36.3%) presented the combined end-point. After multivariable adjustment BE remained independently associated with an adverse outcome (HR 3.80, CI 95% 1.66–8.72). In the subgroup of patients with AF, HAS-BLED score was higher among subjects with BE (3.1 ± 1.3 vs 2.1 ± 0.9, p = 0.003). HAS-BLED score had a significant discrimination power for the occurrence BE (AUC: 0.677 [0.507–0.848]) in this subgroup. CONCLUSIONS: BE are common after MitraClip and are associated with an impaired outcome. Strategies to reduce bleeding events are paramount in this cohort of patients.
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spelling pubmed-61487292018-09-25 Incidence and prognostic implications of late bleeding events after percutaneous mitral valve repair Benito-González, Tomás Estévez-Loureiro, Rodrigo de Prado, Armando Pérez Minguito-Carazo, Carlos del Castillo García, Samuel Garrote-Coloma, Carmen Iglesias-Gárriz, Ignacio Alonso-Rodríguez, David Cardona, Javier Gualis Ramón, Carlos Cuellas Benito, María López Estévez, Julia Vidán Fernández-Vázquez, Felipe Int J Cardiol Heart Vasc Original Paper OBJECTIVES: MitraClip is an established therapy for patients with mitral regurgitation (MR) that are considered of high-risk or inoperable. However, late bleeding events (BE) after hospital discharge and their impact on prognosis in this cohort of patients have been poorly investigated. Our purpose is to address the incidence, related factors and clinical implications of BE after hospital discharge in patients treated with MitraClip. METHODS: Prospective registry of all consecutive patients (n = 80) who underwent MitraClip implantation in our Institution between June 2014 and December 2017. BE were defined according to MVARC definitions. A combined clinical end-point including admission for heart failure (HF) and all-cause mortality was established to analyze prognostic implications of BE. RESULTS: During a median follow up of 523.5 days, 41 BE were reported in 21 patients. Atrial fibrillation (AF, HR 4.54, CI95% 1.20–17.10) and combined antithrombotic therapy at discharge (HR 3.52, CI95% 1.03–11.34) were independently associated with BE. In the study period, 15 (18.8%) patients died, 20 (25%) were admitted for HF and 29 (36.3%) presented the combined end-point. After multivariable adjustment BE remained independently associated with an adverse outcome (HR 3.80, CI 95% 1.66–8.72). In the subgroup of patients with AF, HAS-BLED score was higher among subjects with BE (3.1 ± 1.3 vs 2.1 ± 0.9, p = 0.003). HAS-BLED score had a significant discrimination power for the occurrence BE (AUC: 0.677 [0.507–0.848]) in this subgroup. CONCLUSIONS: BE are common after MitraClip and are associated with an impaired outcome. Strategies to reduce bleeding events are paramount in this cohort of patients. Elsevier 2018-09-19 /pmc/articles/PMC6148729/ /pubmed/30255126 http://dx.doi.org/10.1016/j.ijcha.2018.09.004 Text en © 2018 The Authors http://creativecommons.org/licenses/by-nc-nd/4.0/ This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
spellingShingle Original Paper
Benito-González, Tomás
Estévez-Loureiro, Rodrigo
de Prado, Armando Pérez
Minguito-Carazo, Carlos
del Castillo García, Samuel
Garrote-Coloma, Carmen
Iglesias-Gárriz, Ignacio
Alonso-Rodríguez, David
Cardona, Javier Gualis
Ramón, Carlos Cuellas
Benito, María López
Estévez, Julia Vidán
Fernández-Vázquez, Felipe
Incidence and prognostic implications of late bleeding events after percutaneous mitral valve repair
title Incidence and prognostic implications of late bleeding events after percutaneous mitral valve repair
title_full Incidence and prognostic implications of late bleeding events after percutaneous mitral valve repair
title_fullStr Incidence and prognostic implications of late bleeding events after percutaneous mitral valve repair
title_full_unstemmed Incidence and prognostic implications of late bleeding events after percutaneous mitral valve repair
title_short Incidence and prognostic implications of late bleeding events after percutaneous mitral valve repair
title_sort incidence and prognostic implications of late bleeding events after percutaneous mitral valve repair
topic Original Paper
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6148729/
https://www.ncbi.nlm.nih.gov/pubmed/30255126
http://dx.doi.org/10.1016/j.ijcha.2018.09.004
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