SEX-BASED DIFFERENCES IN OUTCOMES AFTER TRANSCATHETER REPAIR OF MITRAL REGURGITATION WITH THE MITRALCLIP SYSTEM
Villablanca PA, Vemulapalli S, Dai DD, Williams M, Eng M, Staniloae C, Wang DD, Gaba P, Finn M, Leon M, O'Neill W, and Shah B. SEX-BASED DIFFERENCES IN OUTCOMES AFTER TRANSCATHETER REPAIR OF MITRAL REGURGITATION WITH THE MITRALCLIP SYSTEM. J Am Coll Cardiol 2019; 73(9):1046.
J Am Coll Cardiol
Background: Females have a higher rate of adverse events after coronary intervention. Outcomes after transcatheter mitral valve repair (TMVr) intervention by sex remain incompletely elucidated. Methods: Patients (n=5295) who underwent TMVr for mitral regurgitation with the MitraClip system in the STS/ACC TVT registry were evaluated. Linked administrative claims from the Centers for Medicare & Medicaid Services were used to evaluate 1-year clinical outcomes. The adjusted associations between sex and outcomes were evaluated using a multivariable logistic regression model for in-hospital outcomes and Cox model for 1-year outcomes. Results: From November 2013 to March 2017, 2,523 (47.6%) female and 2,772 (52.4%) male patients underwent TMVr. Compared with male patients, female patients were older with lower prevalence of multivessel coronary artery disease, coronary revascularization, and diabetes, but a higher rate of New York Heart Class III-IV functional capacity and home oxygen use (p <0.001 for all). Female patients had a lower glomerular filtration rate, smaller left ventricular cavity but higher ejection fraction, and higher rate of mitral stenosis with more mitral leaflet calcification when compared to male patients. Females were more likely to have only one clip implanted (p <0.001) and lower adjusted odds of MVARC procedural success (aOR 0.78, CI 0.67-0.90) or residual mitral gradient <5 mmHg (aOR 0.54, CI 0.46-0.63) when compared with males. The composite outcome of in-hospital all-cause mortality, stroke, or major bleeding did not significantly differ in females compared with males (adjusted odd ratio [aOR] 1.00, CI 0.82-1.21). At 1-year follow up, female sex was associated with lower all-cause mortality (aHR 0.82, CI 0.69-0.96). However, the 1-year adjusted risk of stroke and any bleeding did not significantly differ by sex. Conclusion: Although females undergoing TMVr had lower odds of procedural success, adjusted 1-year all-cause mortality were lower in females compared with males. Further studies to determine how to further optimize transcatheter management of mitral valve disease by sex are warranted.
9 Suppl 1