• Arturo Giordano, Martino Pepe, Giuseppe Biondi-Zoccai, Nicola Corcione, Filippo Finizio, Paolo Ferraro, Paolo Denti, Popolo RubbioAntonioADepartment of Cardiology, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy., Sonia Petronio, Antonio L Bartorelli, Palma L Nestola, Annalisa Mongiardo, Francesco DE Felice, Marianna Adamo, Matteo Montorfano, Cesare Baldi, Giuseppe Tarantini, Francesco Giannini, Federico Ronco, Ida Monteforte, Emmanuel Villa, Maurizio Ferrario Ormezzano, Luigi Fiocca, Fausto Castriota, Francesco Bedogni, and Corrado Tamburino.
• Unit of Invasive Cardiology, Pineta Grande Hospital, Castel Volturno, Caserta, Italy.
• Panminerva Med. 2023 Dec 1; 65 (4): 443453443-453.

BackgroundThe clinical impact of coronary artery disease (CAD) on the prognosis of patients undergoing MitraClip implantation is still unclear.MethodsOne thousand nine hundred fifty-three patients undergoing MitraClip implantation included in the multicenter GIOTTO Registry were stratified according to CAD. Endpoints were all-cause death, cardiac death, and re-hospitalization for heart failure at follow-up (median 15.8 months).ResultsAlthough younger, CAD patients were more symptomatic, had worse cardiovascular risk profile, higher burden of comorbidities, more frequently affected by functional MR, with higher left ventricle (LV) diameters and lower ejection fraction (EF). At follow-up, CAD patients showed higher rates of all-cause death (25.4% vs. 19.6%; P=0.002), cardiovascular death (14.0% vs. 10.1%; P=0.007) and re-hospitalization for heart failure (13.9% vs. 10.2%; P=0.011). Dividing the population according to mitral regurgitation (MR) etiology (functional vs. non-functional MR), no differences were observed between CAD and no-CAD patients. At multivariate logistic regression, NYHA III/IV class, prior heart failure hospitalization, severe chronic kidney disease, atrial fibrillation, LV end-diastolic diameter and LVEF<30% but not CAD resulted independent predictors of all-cause death. The same finding was confirmed even after propensity score adjustment.ConclusionsCAD did not show a relevant impact on mid-term prognosis per se, but seemed to identify a more complex and diseased cohort of patients with worse clinical and functional status.

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