Incidence and predictors of acute coronary syndrome after transcatheter mitral valve repair

Expert Rev Cardiovasc Ther. 2024 Sep;22(9):517-522. doi: 10.1080/14779072.2024.2398443. Epub 2024 Sep 19.

Abstract

Background: Acute coronary syndrome (ACS) post-transcatheter mitral valve repair (TMVR) carries high mortality. We aim to study the incidence and predictors of ACS in patients who underwent TMVR.

Research design and methods: We queried the U.S. National Readmission Database to identify all cases of TMVR from 2016 to 2019. We further evaluated the incidence of ACS and used multivariable logistic regression to determine independent predictors of ACS in this population.

Results: Among 3,742 patients who underwent TMVR, 264 (7.05%) developed ACS. Among ACS patients, 204 (77%) had non-ST-segment elevation ACS and 66 (25%) had ST-segment elevation ACS. Independent predictors of ACS were acute limb ischemia, cardiogenic shock, history of coronary artery disease (CAD), smoking, cardiac arrest, respiratory failure requiring mechanical ventilation, and acute kidney injury. In-hospital mortality among ACS was three times higher in ACS patients than without ACS (16.76% vs. 5.45%, p-value < 0.01).

Conclusions: ACS is not an uncommon complication after TMVR. The occurrence of ACS after TMVR is associated with high in-hospital mortality, longer length of stay, and higher hospital charges. The strongest predictors of ACS in these patients are the development of acute limb ischemia, cardiogenic shock, and a history of CAD.

Keywords: CAD; Cardiogenic shock; TMVR; acute coronary syndrome; acute limb ischemia; coronary artery disease; transcatheter mitral valve repair.

MeSH terms

  • Acute Coronary Syndrome* / epidemiology
  • Aged
  • Aged, 80 and over
  • Cardiac Catheterization* / adverse effects
  • Cardiac Catheterization* / methods
  • Databases, Factual*
  • Female
  • Heart Valve Prosthesis Implantation* / adverse effects
  • Heart Valve Prosthesis Implantation* / methods
  • Hospital Mortality*
  • Humans
  • Incidence
  • Length of Stay / statistics & numerical data
  • Male
  • Middle Aged
  • Mitral Valve / surgery
  • Mitral Valve Insufficiency* / surgery
  • Patient Readmission / statistics & numerical data
  • Retrospective Studies
  • Risk Factors
  • United States / epidemiology