Surgery still more common than TMVR among AMI patients, but the gap is shrinking
Mitral valve surgery remains much more common than transcatheter mitral valve repair (TMVR) among acute myocardial infarction (AMI) patients, according to a new study published in the American Journal of Cardiology. However, the authors noted, TMVR is gaining momentum as time goes on.
Researchers tracked data from the Nationwide Readmissions Database, believed to include outcomes for approximately half of all U.S. hospitalizations, from 2014 to 2017. All patients were adults who underwent a mitral valve intervention within 30 days of an AMI.
Overall, the team found, 222 patients with a median age of 74 years old underwent TMVR with the MitraClip device from 2014 to 2017. During that same time, 4,738 patients with a median age of 68 years old underwent mitral valve surgery. Four out of five of those procedures were mitral valve replacements; the remaining procedures were mitral valve repairs.
While 21 patients underwent TMVR in 2014, that number increased to 49 in 2015, 55 in 2016 and 97 in 2017. The number of patients undergoing surgery, on the other hand, remained relatively even from one year to the next (1,238 in 2014, 1,333 in 2015, 1,042 in 2016 and 1,125 in 2017).
The authors found that heart failure readmissions were also twice as likely for patients who underwent TMVR. The 30-day all-cause readmission rates, however, were similar between the two groups.
In-hospital mortality was almost identical for the two groups (14.4% after TMVR and 14.1% after surgery). On a similar note, STEMI patients in both groups faced a much higher risk of in-hospital mortality (22.2% after TMVR and 21.9% after surgery).
The indications for TMVR with the MitraClip device and mitral valve surgery appear to be quite different, researchers observed. While high-risk patients were more likely to undergo TMVR, for instance, patients viewed as a lower surgical risk were more likely to be recommended for surgery.
“Due to these potential differences in the indications, this study could not determine the superiority or inferiority between the two mitral valve interventions in this high-risk AMI population,” wrote lead author Toshiaki Isogai, MD, a specialist at the with the Heart, Vascular and Thoracic Institute at the Cleveland Clinic, and colleagues. “Therefore, currently, heart team discussion is a key to improve the treatment selection and outcomes.
Isogai et al. believe this is the first look at mitral valve intervention utilization following an AMI.
“Our data can be used as benchmark data for future studies,” they concluded. “Further efforts are needed to understand the roles of transcatheter, surgical, and medical managements in patients with acute ischemic MR following AMI.”
Read the full analysis here.
Michael has more than 18 years of experience as a professional writer and editor. He has written at length about cardiology, radiology, artificial intelligence and other key healthcare topics.