PB0030 - Relationship between stroke history and the occurrence of adverse events after mitral valve replacement in patients with atrial fibrillation combined with heart valve disease

Background: The risk of stroke and thromboembolism is higher in atrial fibrillation (AF）associated with Valvular heart disease (VHD) than in AF alone. Heart valve replacement (HVR) is the mainstay of treatment for patients with heart valve disease. However, the problems faced in the treatment of HVR are often extremely complex, and the prognosis of patients may vary significantly depending on the individual situation. Therefore, it is important to identify other factors except the choice of anticoagulation strategies affecting the prognosis of patients.

Aims: To investigate the relationship between personal history of stroke and clinical events occurring after valve replacement in patients with AF combined with VHD.

Methods: We enrolled 746 patients who underwent valve replacement with AF from January 2018 to December 2019 in Wuhan Asia Heart Hospital. General information of patients were collected through the hospital's electronic medical record system. Patients were followed up using outpatient or telephone until the endpoint event occurred, with a maximum follow-up of 24 months. The incidence of thrombotic, hemorrhagic, and fatal events during the follow-up period was compared between the two groups. Independent risk factors for endpoint events were analyzed using Cox regression.

Results: The rate of overall clinical events (8.3% versus 4.1%, P=0.018), thrombotic events (3.9% versus 0.4%, P< 0.001), and all-cause mortality events (4.4% versus 0.8%, P< 0.001) were higher in the group with a history of stroke than in the group without a history of stroke. The difference was not statistically significant. Multifactorial Cox regression analysis showed that a personal history of stroke was associated with higher rates of overall clinical events (HR=2.08, P=0.021), thrombotic events (HR=10.33, P= 0.003) and all-cause mortality events (HR=5.72, P=0.002) were all independently associated.

Conclusion(s): Personal history of stroke is significantly associated with adverse events after valve replacement for atrial fibrillation combined with heart valve disease.