SPC365

Adverse Events While Waiting for Valvular Intervention: Identifying Modifiable Risk Factors

Session: SESSÃO DE POSTERS 50 - DIAGNÓSTICO E PROGNÓSTICO NA CIRURGIA CARDÍACA
Speaker: Carolina Pereira Mateus

Congress: CPC 2025
Topic: F. Valvular, Myocardial, Pericardial, Pulmonary, Congenital Heart Disease
Theme: 15. Valvular Heart Disease
Subtheme: 15.2 Valvular Heart Disease – Epidemiology, Prognosis, Outcome
Session Type: Cartazes
FP Number: ---
Authors: Carolina Pereira Mateus; Inês Miranda; Filipa Gerardo; Rodrigo Brandão; Mariana Passos; Inês Fialho; Pedro Farto e Abreu; Márcio Madeira; Miguel Santos; Sérgio Bravo Baptista; José Neves; Carlos Morais

<p style="text-align:justify"><span style="font-size:12px"><span style="font-family:Arial,Helvetica,sans-serif"><strong><span style="color:black">Introduction</span></strong><span style="color:black">:</span></span></span></p>

<p style="text-align:justify"><span style="font-size:12px"><span style="font-family:Arial,Helvetica,sans-serif"><span style="color:black">Patients with valvular heart disease (VHD) are categorized into priority groups to optimize timing for intervention. Delays beyond the recommended waiting time for intervention (RWT) can increase the risk of adverse outcomes.</span></span></span></p>

<p style="text-align:justify"><span style="font-size:12px"><span style="font-family:Arial,Helvetica,sans-serif"><span style="color:black">This study evaluates the incidence and predictors of major adverse cardiovascular events (MACE) in a contemporary cohort discussed by a Heart Team (HT).</span></span></span></p>

<p style="text-align:justify"><span style="font-size:12px"><span style="font-family:Arial,Helvetica,sans-serif"><strong><span style="color:black">Methods</span></strong><span style="color:black">:</span></span></span></p>

<p style="text-align:justify"><span style="font-size:12px"><span style="font-family:Arial,Helvetica,sans-serif"><span style="color:black">A retrospective, single-center study was conducted on all patients evaluated by the HT for valvular intervention between January 2018 and June 2021. Clinical records were reviewed for demographic data, comorbidities, therapeutic decisions, time on waiting list and MACE incidence (i.e. death, stroke, myocardial infarction, hospital readmission and heart failure exacerbation).</span> <span style="color:black">Demographic and clinical data were analyzed, and predictors of MACE were identified using logistic regression.</span></span></span></p>

<p style="text-align:justify"><span style="font-size:12px"><span style="font-family:Arial,Helvetica,sans-serif"><strong><span style="color:black">Results</span></strong><span style="color:black">:</span></span></span></p>

<p style="text-align:justify"><span style="font-size:12px"><span style="font-family:Arial,Helvetica,sans-serif"><span style="color:black">A total of 312 patients with VHD were discussed in HT, with a median age of 76 years, (49.1% male). Aortic stenosis was the most common diagnosis (</span>76.0%), followed by <span style="color:black">mitral regurgitation (14.1%) and mitral stenosis (8.0%). The HT proposed valvular intervention in 92.0% of patients, while 8.0% received a conservative approach.</span></span></span></p>

<p style="text-align:justify"><span style="font-size:12px"><span style="font-family:Arial,Helvetica,sans-serif"><span style="color:black">The mean waiting time for intervention </span>was 233 days (7.4 months), with <span style="color:black">74.4% exceeded the RWT. MACE occurred in 26.5% of patients, including death (12.6%), hospital readmissions (16.4%), and heart failure exacerbations (17.7%).</span></span></span></p>

<p style="text-align:justify"><span style="font-size:12px"><span style="font-family:Arial,Helvetica,sans-serif"><span style="color:black">Significant predictors of MACE included exceeding the RWT (p=0.002), previous heart failure hospitalization (p=0.001), atrial fibrillation (p=0.002), NYHA class &ge;3 (p=0.004), 2 or 3 vessel coronary artery disease (p=0.004), estimated Glomerular Filtration Rate (eGFR) &lt;51 mL/min/1,73m<sup>2</sup> (p&lt;0.001), hemoglobin &lt;12.4g/dL (p=0.027), NT-proBNP levels &gt;1709pg/mL (p=0.013), waiting time for intervention &gt;11months (p=0.016), and EUROSCORE II risk &gt;3.44% (p=0.001).</span></span></span></p>

<p style="text-align:justify"><span style="font-size:12px"><span style="font-family:Arial,Helvetica,sans-serif"><span style="color:black">Logistic regression revealed that exceeding the RWT contributed to 18.5% of MACE risk, alongside NYHA class &ge;3 and NT-proBNP levels &gt;1709pg/mL.</span></span></span></p>

<p style="text-align:justify"><span style="font-size:12px"><span style="font-family:Arial,Helvetica,sans-serif"><strong><span style="color:black">Conclusion:</span></strong></span></span></p>

<p><span style="font-size:12px"><span style="font-family:Arial,Helvetica,sans-serif"><span style="color:black">The incidence of MACE while awaiting valvular intervention is high, particularly in patients exceeding the RWT or with severe heart failure and elevated NT-proBNP. These findings highlight the critical need for timely intervention and effective stratification of priority groups to reduce adverse outcomes.</span></span></span></p>