Conservative, surgical and percutaneous treatment for mitral regurgitation shortly after acute myocardial infarction
2Interventional Cardiology Unit, Hospital Álvaro Cunqueiro, Spain
3Interventional Cardiology Unit, Complejo Asistencial Universitario de Leon, Spain
4Cardiovascular surgery department, San Raffaele University Hospital, Italy
5Interventional Cardiology Unit, Hospital Sant Pau i Santa Creu, Spain
6Cardiac Catheterization Laboratory, ASST Spedali Civili di Brescia, Italy
7Interventional Cardiology Unit, Hospital Clinic, Spain
8Hospital Clínico San Carlos,, Instituto de Investigacion Sanitaria San Carlos, IdISSC, Spain
9The Center for Structural Heart Disease, Henry Ford Hospital, USA
10Department of Cardiology, Kantonsspital Baden, Switzerland
11Division of Cardiology, St. Michael's Hospital, University of Toronto, Canada
12Department of Transcatheter Heart Valves, HYGEIA Hospital, Greece
13Department of Cardiology, Hospital Universitario Central de Asturias, Spain
14Schulich Heart Centre, Sunnybrook Health Sciences Centre, University of Toronto, Canada
15Inselspital, Bern University Hospital, Switzerland
16Cardiovascular Institute, Baruch Padeh Medical Center, Israel
17Department of Cardiology, Rambam Medical Center, Israel
18Department of Cardiology, Interbalkan European Medical Center, Greece
19Department of Cardiovascular Surgery, IRCCS Centro Cardiologico Monzino, Italy
20Heart Institute, Hadassah-Hebrew University Medical Center, Israel
21Cardiology Department, Rabin Medical Center, Israel
22Leviev Heart Center, Sheba Medical Center, Israel
23Heart center, Wolfson Medical Center, Israel
24Heart Valve Clinic, University Hospital of Zurich, Switzerland
25Jesselson Integrated Heart Centre, Shaare Zedek Medical Center, Israel
Aims: Severe mitral regurgitation (MR) following acute myocardial infarction (MI) is associated with high mortality rates and has inconclusive recommendations in clinical guidelines.
We aimed to report the international experience of patients with MR following acute MI and compare the outcomes of those treated conservatively, surgically and percutaneously.
Methods and Results: Retrospective international registry of consecutive patients with at least moderate-to-severe MR following MI treated in 21 centers in North America, Europe and the Middle East. The registry included patients treated conservatively and those having surgical mitral valve repair or replacement (SMVR) or percutaneous mitral valve repair (PMVR) using the MitraClip device. The primary endpoint was in-hospital mortality.
A total of 517 patients were included (43% females, age 73±11 years): 235 underwent Interventions, of which 130 were SMVR and 105 PMVR. Patients who underwent mitral valve intervention were in a worse clinical state (Killip class >3 in 64% vs. 45%, P<0.001), but yet had lower in-hospital and 1-year mortality compared with those treated conservatively (16% vs. 30%, p<0.001 and 31% vs. 47%, p<0.01, respectively; HR 0.21, CI 0.12 – 0.36, P<0.001). The immediate procedural success did not differ between the SMVR and PMVR (95% vs. 91%, P=0.29). However, in-hospital and 1-year mortality rates were significantly higher in SMVR (22% vs. 9%, P<0.01 and 37% vs. 19%, P=0.03, respectively; HR 0.28, CI 0.12–0.37, P<0.001).
Conclusions: Early intervention may mitigate the poor prognosis associated with conservative therapy in patients with post-MI MR. Percutaneous edge-to-edge repair may to be preferred over surgery. Randomized control trials are warranted to further clarify this issue.
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