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)

Rodrigo Estévez-Loureiro*, Mony Shuvy, Maurizio Taramasso, Tomas Benito-Gonzalez, Paolo Denti, Dabit Arzamendi, Marianna Adamo, Xavier Freixa, Pedro Villablanca, Lian Krivoshei, Neil Fam, Konstantinos Spargias, Andrew Czarnecki, Dan Haberman, Yoram Agmon, Doron Sudarsky, Isaac Pascual, Vlasis Ninios, Salvatore Scianna, Igal MoarafDavide Schiavi, Michael Chrissoheris, Ronen Beeri, Arthur Kerner, Estefanía Fernández-Peregrina, Mattia Di Pasquale, Ander Regueiro, Lion Poles, Andres Iñiguez-Romo, Felipe Fernández-Vázquez, Francesco Maisano

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

34 Scopus citations

Abstract

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 eight 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 =.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 =.793). Likewise, immediate procedural success (90% CS vs. 93% non-CS; p =.793) and need for reintervention (CS 6% vs. non-CS 2.3%, p =.621) or re-admission due to HF (CS 13% vs. NCS 23%, p =.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 =.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.

Original languageAmerican English
Pages (from-to)1259-1267
Number of pages9
JournalCatheterization and Cardiovascular Interventions
Volume97
Issue number6
DOIs
StatePublished - 1 May 2021

Bibliographical note

Funding Information:
Rodrigo Estévez‐Loureiro is consultant for Abbott Vascular and Boston Scientific. Dr. Taramasso is a consultant for Abbott Vascular, Boston Scientific, 4TECH, and CoreMedic; and has received speaker honoraria from Edwards Lifesciences. Dr. Denti has served as a consultant for Abbott Vascular, 4Tech, Neovasc, and InnovHeart; and has received honoraria from Abbott. Dabit Arzamendi is consultant for Abbott Vascular. Dr. Xavier Freixa is consultants for Abbott Vascular. Dr. Fam, has received speaker honoraria and travel or grant support from Edwards Lifesciences Francesco Maisano received Grant and/or Research Support from Abbott, Medtronic, Edwards Lifesciences, Biotronik, Boston Scientific Corporation, NVT, Terumo; receives Consulting fees, Honoraria from Abbott, Medtronic, Edwards Lifesciences, Swissvortex, Perifect, Xeltis, Transseptal solutions, Cardiovalve, Magenta; has Royalty Income/IP Rights Edwards Lifesciencesand is Shareholder of Cardiovalve, Cardiogard, Magenta, SwissVortex, Transseptalsolutions, 4Tech, Perifect. All other authors have reported that they have no relationships relevant to the contents of this article to disclose.

Publisher Copyright:
© 2021 Wiley Periodicals LLC.

Keywords

  • MitraClip
  • acute myocardial infarction
  • cardiogenic shock
  • mitral regurgitation
  • percutaneous mitral valve repair

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