Use of MitraClip for mitral valve repair in patients with acute mitral regurgitation following acute myocardial infarction: effect of cardiogenic shock on outcomes. IREMMI registry
2Interventional Cardiology Unit., Hospital Álvaro Cunqueiro, Spain
3Heart Valve Clinic,, University Hospital of Zurich, Switzerland
4Interventional Cardiology Unit, Complejo Asistencial Universitario de Leon, Spain
5Cardiovascular surgery department., San Raffaele University Hospital,, Italy
6Hospital Clinic,, Interventional Cardiology Unit., Spain
7Interventional Cardiology Unit, Hospital Sant Pau i Santa Creu,, Spain
8Kaplan Medical Center,, Heart center, Israel
9Shulich Heart Centre, Division of Cardiology,, Sunnybrook Heath Sciences centre, Canada
Objectives: To assess outcomes in patients with acute mitral regurgitation (MR)
following acute myocardial infarction (AMI) who received percutaneous mitral valve
repair (PMVR) with the MitraClip device and to compare outcomes of patients who
developed cardiogenic shock (CS) to those who did not (non-CS).
Background: Acute MR after AMI may lead to CS and is associated with high
mortality.
Methods: This registry analyzed patients with MR after AMI who were treated with
MitraClip at 18 centers within 8 countries between January 2016 and February 2020.
Patients were stratified into CS and non-CS groups. Primary outcomes were mortality
and rehospitalization due to heart failure. Secondary outcomes were acute procedural
success, functional improvement, and MR reduction. Multivariable Cox regression
analysis evaluated association of CS with clinical outcomes.
Results: Among 93 patients analyzed (age 70.3±10.2 years), 50 patients (53.8%)
experienced CS before PMVR. Mortality at 30 days (10% CS vs. 2.3% non-CS;
P=0.212) did not differ between groups. After median follow-up of 7 months (IQR 2.5-
17 months), the combined event mortality/re-hospitalization was similar (28% CS vs.
25.6% non-CS; P=0.793). Likewise, immediate procedural success (90% CS vs. 93%
non-CS; P=0.793) and need for reintervention (CS 6% vs. non-CS 2.3%, p=0.621) or
re-admission due to HF (CS 13% vs. NCS 23%, p=0.253) at 3 months did not differ. CS
was not independently associated with the combined end-point (hazard ratio 1.1; 95%
CI, 0.3-4.6; P=0.889).
Conclusions: Patients found to have significant MR during their index hospitalization
for AMI had similar clinical outcomes with PMVR whether they presented in or out of cardiogenic shock, provided initial hemodynamic stabilization was first achieved before
PMVR.
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