Transcatheter edge-to-edge repair in severe mitral regurgitation following acute myocardial infarction – aetiology-based analysis

Dan Haberman*, Rodrigo Estévez-Loureiro, Andrew Czarnecki, Francesco Melillo, Marianna Adamo, Pedro Villablanca, Doron Sudarsky, Fabien Praz, Leor Perl, Xavier Freixa, Andrea Scotti, Paul Fefer, Konstantinos Spargias, Neil Fam, Lisa Manevich, Giulia Masiero, Luis Nombela-Franco, Isaac Pascual, Gabriele Crimi, Vlasis NiniosRonen Beeri, Tomas Benito-Gonzalez, Dabit Arzamendi, Estefanıa Fernández-Peregrina, Francesco Giannini, Antonio Mangieri, Lion Poles, Jacob George, Julio Cesar Echarte Morales, Berenice Caneiro-Queija, Paolo Denti, Davide Schiavi, Azeem Latib, Michael Chrissoheris, Haim Danenberg, Giuseppe Tarantini, Danny Dvir, Francesco Maisano, Maurizio Taramasso, Mony Shuvy

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

Abstract

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.

Original languageEnglish
JournalEuropean Journal of Heart Failure
StateAccepted/In press - 2025

Bibliographical note

Publisher Copyright:
© 2025 European Society of Cardiology.

Keywords

  • Cardiogenic shock
  • Mitral regurgitation
  • Myocardial infarction
  • Papillary muscle rupture
  • Transcatheter edge-to-edge repair

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