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Early percutaneous mitral commissurotomy or conventional management for asymptomatic mitral stenosis: a randomised clinical trial.

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Alternative Title
Heart. 2021 Dec;107(24):1980-1986.
Abstract
Abstract


Objective: The decision to perform percutaneous mitral commissurotomy (PMC) on asymptomatic patients requires careful weighing of the potential benefits against the risks of PMC, and we conducted a multicentre, randomised trial to compare long-term outcomes of early PMC and conventional treatment in asymptomatic, severe mitral stenosis (MS).

Methods: We randomly assigned asymptomatic patients with severe MS (defined as mitral valve area between 1.0 and 1.5 cm2) to early PMC (84 patients) or to conventional treatment (83 patients). The primary endpoint was a composite of major cardiovascular events, including PMC-related complications, cardiovascular mortality, cerebral infarction and systemic thromboembolic events. The secondary endpoints were death from any cause and mitral valve (MV) replacement during follow-up.

Results: In the early PMC group, there were no PMC-related complications. During the median follow-up of 6.4 years, the composite primary endpoint occurred in seven patients in the early PMC group (8.3%) and in nine patients in the conventional treatment group (10.8%) (HR 0.77; 95% CI 0.29 to 2.07; p=0.61). Death from any cause occurred in four patients in the early PMC group (4.8%) and three patients in the conventional treatment group (3.6%) (HR 1.30; 95% CI 0.29 to 5.77). Ten patients (11.9%) in the early PMC group and 17 patients (20.5%) in the conventional treatment group underwent MV replacement (HR 0.59; 95% CI 0.27 to 1.29).

Conclusions: Compared with conventional treatment, early PMC did not significantly reduce the incidence of cardiovascular events among asymptomatic patients with severe MS during the median follow-up of 6 years.
Author(s)
강덕현김대희박덕우박성지박승우박승정송종민윤성철이사민이승아홍그루홍명기
Issued Date
2021
Type
Article
Keyword
echocardiographyendovascular proceduresmitral valve stenosis.
DOI
10.1136/heartjnl-2021-319857
URI
https://oak.ulsan.ac.kr/handle/2021.oak/7231
https://ulsan-primo.hosted.exlibrisgroup.com/primo-explore/fulldisplay?docid=TN_cdi_proquest_miscellaneous_2573437098&context=PC&vid=ULSAN&lang=ko_KR&search_scope=default_scope&adaptor=primo_central_multiple_fe&tab=default_tab&query=any,contains,Early%20percutaneous%20mitral%20commissurotomy%20or%20conventional%20management%20for%20asymptomatic%20mitral%20stenosis:%20a%20randomised%20clinical%20trial.&offset=0&pcAvailability=true
Publisher
HEART
Location
미국
Language
영어
ISSN
1355-6037
Citation Volume
107
Citation Number
24
Citation Start Page
1980
Citation End Page
1986
Appears in Collections:
Medicine > Medicine
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