Lemor, Alejandro

Background: Women have a higher rate of adverse events after mitral valve surgery. We sought to evaluate whether outcomes after transcatheter edge-to-edge repair intervention by sex have similar trends to mitral valve surgery. Methods: The primary outcome was 1-year major adverse events defined as a composite of all-cause mortality, stroke, and any bleeding in the overall study cohort. Patients who underwent transcatheter edge-to-edge repair for mitral regurgitation with the MitraClip system in the Society of Thoracic Surgery/American College of Cardiology Transcatheter Valve Therapy registry were evaluated. Linked administrative claims from the Centers for Medicare and Medicaid Services were used to evaluate 1-year clinical outcomes. 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, 5295 patients, 47.6% (n=2523) of whom were female, underwent transcatheter edge-to-edge repair. Females were less likely to have >1 clip implanted ( P <0.001) and had a lower adjusted odds ratio of device success (adjusted odds ratio, 0.78 [95% CI, 0.67–0.90]), driven by lower odds of residual mitral gradient <5 mm Hg (adjusted odds ratio, 0.54 [CI, 0.46–0.63]) when compared with males. At 1-year follow-up, the primary outcome did not differ by sex. Female sex was associated with lower adjusted 1-year risk of all-cause mortality (adjusted hazard ratio, 0.80 [CI, 0.68–0.94]), but the adjusted 1-year risk of stroke and any bleeding did not differ by sex. Conclusions: No difference in composite outcome of all-cause mortality, stroke, and any bleeding was observed between females and males. Adjusted 1-year all-cause mortality was lower in females compared with males.

Background Reducing readmission after catheter ablation ( CA ) in atrial fibrillation (AF) is important. Methods and Results We utilized National Readmission Data ( NRD ) 2010–2014. AF was identified by International Classification of Diseases, Ninth Edition, Clinical Modification (ICD‐9‐CM) diagnostic code 427.31 in the primary field, while first CA of AF was identified via ICD‐9 ‐procedure code 37.34. Any admission within 30 or 90 days of index admission was considered a readmission. Cox proportional hazard regression was used to adjust for confounders. The primary outcomes were 30‐ and 90‐day readmissions and the secondary outcome was AF recurrence. In total, 1 128 372 patients with AF were identified from January 1, 2010 to September 30, 2014. Of which 37 360 (3.3%) underwent CA . Patients aged ≥65 years and female sex were less likely to receive CA for AF . Overall, 10.9% and 16.5% of CA patients were readmitted within 30 and 90 days post‐CA, respectively. Most common causes of readmissions were arrhythmia ( AF , atrial flutter), heart failure, pulmonary causes (pneumonia, chronic obstructive pulmonary disease) and bleeding complications (gastrointestinal bleed, intracranial hemorrhage). Patients with diabetes mellitus, heart failure, coronary artery disease ( CAD ), chronic pulmonary and kidney disease, prior stroke/transient ischemic attack (TIA), female sex, length of stay ≥2 and disposition to the facility were prone to higher 30‐ and 90‐day readmissions post ‐CA . Predictors of increase in AF recurrence post‐ CA were female sex, diabetes mellitus, chronic pulmonary disease, and length of stay ≥2. Trends of 90‐day readmission and AF recurrence were found to improve over the study period. Conclusions We identified several demographic and clinical factors associated with the use of CA in AF , and short‐term outcomes of the same, which could potentially help in the patient selection and improve outcomes.