TY - JOUR
T1 - Transcatheter edge-to-edge repair in severe mitral regurgitation following acute myocardial infarction – aetiology-based analysis
AU - Haberman, Dan
AU - Estévez-Loureiro, Rodrigo
AU - Czarnecki, Andrew
AU - Melillo, Francesco
AU - Adamo, Marianna
AU - Villablanca, Pedro
AU - Sudarsky, Doron
AU - Praz, Fabien
AU - Perl, Leor
AU - Freixa, Xavier
AU - Scotti, Andrea
AU - Fefer, Paul
AU - Spargias, Konstantinos
AU - Fam, Neil
AU - Manevich, Lisa
AU - Masiero, Giulia
AU - Nombela-Franco, Luis
AU - Pascual, Isaac
AU - Crimi, Gabriele
AU - Ninios, Vlasis
AU - Beeri, Ronen
AU - Benito-Gonzalez, Tomas
AU - Arzamendi, Dabit
AU - Fernández-Peregrina, Estefanıa
AU - Giannini, Francesco
AU - Mangieri, Antonio
AU - Poles, Lion
AU - George, Jacob
AU - Echarte Morales, Julio Cesar
AU - Caneiro-Queija, Berenice
AU - Denti, Paolo
AU - Schiavi, Davide
AU - Latib, Azeem
AU - Chrissoheris, Michael
AU - Danenberg, Haim
AU - Tarantini, Giuseppe
AU - Dvir, Danny
AU - Maisano, Francesco
AU - Taramasso, Maurizio
AU - Shuvy, Mony
N1 - Publisher Copyright:
© 2025 European Society of Cardiology.
PY - 2025
Y1 - 2025
N2 - Aims: To evaluate the association between transcatheter edge-to-edge repair (TEER) and outcomes in patients with significant mitral regurgitation (MR) following acute myocardial infarction (MI), focusing on the aetiology of acute post-MI MR in high-risk surgical patients. Methods and results: The International Registry of MitraClip in Acute Mitral Regurgitation following Acute Myocardial Infarction (IREMMI) includes 187 patients with severe MR post-MI managed with TEER. Of these, 176 were included in the analysis, 23 (13%) patients had acute papillary muscle rupture (PMR) and 153 (87%) acute secondary MR. The mean age was 70 ± 10 years and 41% were female. PMR patients had fewer cardiovascular risk factors: hypertension (52% vs. 73%, p = 0.04), diabetes (26% vs. 48%, p < 0.01) but a higher left ventricular ejection fraction (45± 15% vs.35± 10%, p < 0.01) compared secondary MR patients. PMR patients were more likely to present in cardiogenic shock (91% vs. 51%, p = 0.001), require mechanical circulatory support (74% vs. 34%, p = 0.01), and had a higher EuroSCORE II (23± 13% vs. 13± 11%, p = 0.011). The median time from MI to TEER was shorter in PMR (6 days) versus secondary MR (20 days) (p < 0.01). Procedural success was similar (87% vs. 92%, p = 0.49) with comparable MR grade reduction. However, PMR patients had significantly higher in-hospital mortality rates (adjusted odds ratio [OR] 3.05, 95% confidence interval [CI] 1.15–8.12, p = 0.02), 30-day mortality rates (unadjusted OR 3.99, 95% CI 1.42–11.26, p = 0.01) and a higher rate of conversion to surgical mitral valve replacement (22% vs. 3%, p < 0.01) (unadjusted OR 8.17, 95% CI 2.15–30.96, p < 0.001). Aetiology of MR, cardiogenic shock, and procedure timing significantly impacted in-hospital mortality. After adjusting for EuroSCORE II and cardiogenic shock, MR aetiology remained the strongest predictor (adjusted OR 6.71; 95% CI 2.06–21.86, p < 0.01). Conclusion: Transcatheter edge-to-edge repair may be considered a salvage or bridge procedure in decompensated post-MI MR patients of both aetiologies; however, patients with PMR have a higher risk of mortality and conversion to surgery.
AB - Aims: To evaluate the association between transcatheter edge-to-edge repair (TEER) and outcomes in patients with significant mitral regurgitation (MR) following acute myocardial infarction (MI), focusing on the aetiology of acute post-MI MR in high-risk surgical patients. Methods and results: The International Registry of MitraClip in Acute Mitral Regurgitation following Acute Myocardial Infarction (IREMMI) includes 187 patients with severe MR post-MI managed with TEER. Of these, 176 were included in the analysis, 23 (13%) patients had acute papillary muscle rupture (PMR) and 153 (87%) acute secondary MR. The mean age was 70 ± 10 years and 41% were female. PMR patients had fewer cardiovascular risk factors: hypertension (52% vs. 73%, p = 0.04), diabetes (26% vs. 48%, p < 0.01) but a higher left ventricular ejection fraction (45± 15% vs.35± 10%, p < 0.01) compared secondary MR patients. PMR patients were more likely to present in cardiogenic shock (91% vs. 51%, p = 0.001), require mechanical circulatory support (74% vs. 34%, p = 0.01), and had a higher EuroSCORE II (23± 13% vs. 13± 11%, p = 0.011). The median time from MI to TEER was shorter in PMR (6 days) versus secondary MR (20 days) (p < 0.01). Procedural success was similar (87% vs. 92%, p = 0.49) with comparable MR grade reduction. However, PMR patients had significantly higher in-hospital mortality rates (adjusted odds ratio [OR] 3.05, 95% confidence interval [CI] 1.15–8.12, p = 0.02), 30-day mortality rates (unadjusted OR 3.99, 95% CI 1.42–11.26, p = 0.01) and a higher rate of conversion to surgical mitral valve replacement (22% vs. 3%, p < 0.01) (unadjusted OR 8.17, 95% CI 2.15–30.96, p < 0.001). Aetiology of MR, cardiogenic shock, and procedure timing significantly impacted in-hospital mortality. After adjusting for EuroSCORE II and cardiogenic shock, MR aetiology remained the strongest predictor (adjusted OR 6.71; 95% CI 2.06–21.86, p < 0.01). Conclusion: Transcatheter edge-to-edge repair may be considered a salvage or bridge procedure in decompensated post-MI MR patients of both aetiologies; however, patients with PMR have a higher risk of mortality and conversion to surgery.
KW - Cardiogenic shock
KW - Mitral regurgitation
KW - Myocardial infarction
KW - Papillary muscle rupture
KW - Transcatheter edge-to-edge repair
UR - http://www.scopus.com/inward/record.url?scp=85215124353&partnerID=8YFLogxK
M3 - ???researchoutput.researchoutputtypes.contributiontojournal.article???
C2 - 39809715
AN - SCOPUS:85215124353
SN - 1388-9842
JO - European Journal of Heart Failure
JF - European Journal of Heart Failure
ER -