Bleeding following mitral transcatheter edge-to-edge repair (TEER) is associated with increased risk of death or hospital readmission, according to a study published Oct. 28 in JACC: Cardiovascular Interventions.

Nickpreet Singh, MD, et al., included 51,533 patients from the STS/ACC TVT Registry between 2013 and 2022 to compare the primary endpoint – the composite of death or hospital readmission at 30 days – among patients with in-hospital major or life-threatening bleeding vs. patients without bleeding. The authors also analyzed the association between bleeding events and death or readmission at one year and identified independent predictors of major in-hospital bleeding.

Out of all patients included, 2.3% experienced in-hospital major bleeding, with rates decreasing over the study period (from 7.1% in 2013 to 2.0% in 2021; p<0.001). In-hospital bleeding was associated with increased risk of death or readmission at 30 days (adjusted odds ratio [aOR], 2.15 [95% CI, 1.81-2.54]; p<0.0001) as well as at one year (adjusted hazard ratio, 1.43 [95% CI, 1.27-1.60]; p<0.0001).

Strongest independent predictors of in-hospital bleeding included female sex, prior PCI, baseline hemoglobin, greater procedure acuity and longer procedure duration.

“While we found that major bleeding events after [mitral TEER] were relatively uncommon in the last several years, bleeding still represents one of the most common complications of [mitral TEER],” write the authors. “Moreover, the association of bleeding with subsequent mortality and hospital readmission suggests that additional efforts to implement strategies to prevent periprocedural bleeding are warranted.”

In an accompanying editorial comment, Roxana Mehran, MD, FACC, and Mauro Gitto, MD, add: “As awareness of the prognostic significance of bleeding grows, considerable effort is needed to improve the care of patients undergoing [mitral TEER]. Future trials should incorporate bleeding events as a key endpoint and investigate the optimal post-discharge antithrombotic strategy, as well as consider sex as an important biologic variable to evaluate the safety and efficacy of [mitral TEER] procedures.”

Keywords: National Cardiovascular Data Registries, STS/ACC TVT Registry, Hemorrhage, Transcatheter Cardiovascular Therapeutics