Multiple percutaneous coronary interventions worsen outcomes for subsequent surgical correction of chronic ischemic mitral regurgitation

Satoshi Kainuma; Koichi Toda; Shigeru Miyagawa; Daisuke Yoshioka; Takuji Kawamura; Ai Kawamura; Noriyuki Kashiyama; Toru Kuratani; Kensuke Yokoi; Seiko Ide; Isamu Mizote; Hidetaka Kioka; Tomohito Ohtani; Shungo Hikoso; Haruhiko Kondoh; Arudo Hiraoka; Taichi Sakaguchi; Hidenori Yoshitaka; Tetsuhisa Kitamura; Sho Komukai; Atsushi Hirayama; Kazuhiro Taniguchi; Yasushi Sakata; Yoshiki Sawa; Osaka Cardiovascular Surgery Research Group

doi:10.1016/j.xjon.2021.07.037

Multiple percutaneous coronary interventions worsen outcomes for subsequent surgical correction of chronic ischemic mitral regurgitation

JTCVS Open. 2021 Aug 18:7:195-206. doi: 10.1016/j.xjon.2021.07.037. eCollection 2021 Sep.

Authors

Satoshi Kainuma¹, Koichi Toda¹, Shigeru Miyagawa¹, Daisuke Yoshioka¹, Takuji Kawamura¹, Ai Kawamura¹, Noriyuki Kashiyama¹, Toru Kuratani¹, Kensuke Yokoi², Seiko Ide², Isamu Mizote², Hidetaka Kioka², Tomohito Ohtani², Shungo Hikoso², Haruhiko Kondoh³, Arudo Hiraoka⁴, Taichi Sakaguchi⁴, Hidenori Yoshitaka⁴, Tetsuhisa Kitamura⁵, Sho Komukai⁶, Atsushi Hirayama⁷, Kazuhiro Taniguchi³, Yasushi Sakata², Yoshiki Sawa¹; Osaka Cardiovascular Surgery Research Group

Collaborators

Osaka Cardiovascular Surgery Research Group:
Yasushi Yoshikawa, Hiroki Hata, Toshihiro Funatsu, Takafumi Masai, Yukitoshi Shirakawa, Toshiki Takahashi, Hiroyuki Nishi, Masashi Kawamura, Osamu Monta, Takashi Yamauchi

Affiliations

¹ Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, Suita, Osaka, Japan.
² Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, Suita, Osaka, Japan.
³ Department of Cardiovascular Surgery, Japan Organization of Occupational Health and Safety Osaka Rosai Hospital, Sakai, Osaka, Japan.
⁴ Department of Cardiovascular Surgery, Sakakibara Heart Institute of Okayama, Okayama, Japan.
⁵ Division of Environmental Medicine and Population Sciences, Department of Social and Environmental Medicine, Osaka University Graduate School of Medicine, Suita, Osaka, Japan.
⁶ Division of Biomedical Statistics, Department of Integrated Medicine, Osaka University Graduate School of Medicine, Suita, Osaka, Japan.
⁷ Division of Public Health, Department of Social Medicine, Osaka University Graduate School of Medicine, Suita, Osaka, Japan.

Abstract

Objective: We investigated whether or not a history of multiple percutaneous coronary interventions (PCIs) is associated with clinical outcomes after surgery for ischemic mitral regurgitation.

Methods: A total of 309 patients with chronic ischemic mitral regurgitation and left ventricular ejection fraction ≤40% who underwent restrictive mitral annuloplasty were classified as follows: patients with no or 1 previous PCI (nonmultiple PCI group [n = 211]) and patients with 2 or more previous PCIs (multiple PCIs group [n = 98]). Mean follow-up duration was 53 ± 40 months.

Results: Before surgery, there were no intergroup differences in patient demographic characteristics except for lower estimated glomerular filtration rate in patients with multiple PCIs. These patients underwent concomitant coronary artery bypass grafting less frequently with a lower number of distal anastomoses (P < .05 for both). The 30-day mortality was 3.3% and 2.0% in the nonmultiple and multiple PCIs group, respectively (P = .72). During follow-up, there were 157 deaths. Patients with multiple PCIs showed lower 5-year survival rate (44% vs 64%; P = .002). After adjustments with inverse-probability-of-treatment weighting, multiple PCIs history was an independent risk factor for mortality (adjusted hazard ratio, 1.4; 95% confidential interval, 1.1-1.7; P = .002). Patients with multiple PCIs showed less improvement in left ventricular ejection fraction (interaction effect P < .001).

Conclusions: In patients with ischemic mitral regurgitation, a history of previous multiple PCIs was associated with increased risk of long-term postoperative mortality, with less improvement in left ventricular ejection fraction.

Keywords: CABG, coronary artery bypass grafting; IPTW, inverse-probability-of-treatment weighting; LV, left ventricular; MR, mitral regurgitation; PCI, percutaneous coronary intervention; RMA, restrictive mitral annuloplasty; SMDs, standardized mean differences; coronary artery bypass grafting; ischemic mitral regurgitation; left ventricular reverse remodeling; percutaneous coronary intervention; restrictive mitral annuloplasty.