Conservative, surgical, and percutaneous treatment for mitral regurgitation shortly after acute myocardial infarction
Por:
Haberman D., Estévez-Loureiro R., Benito-Gonzalez T., Denti P., Arzamendi D., Adamo M., Freixa X., Nombela-Franco L., Villablanca P., Krivoshei L., Fam N., Spargias K., Czarnecki A., Pascual I., Praz F., Sudarsky D., Kerner A., Ninios V., Gennari M., Beeri R., Perl L., Wasserstrum Y., Danenberg H., Poles L., George J., Caneiro-Queija B., Scianna S., Moaraf I., Schiavi D., Scardino C., Corpataux N., Echarte-Morales J., Chrissoheris M., Fernández-Peregrina E., Pasquale M.D., Regueiro A., Vergara-Uzcategui C., Iñiguez-Romo A., Fernández-Vázquez F., Dvir D., Maisano F., Taramasso M., Shuvy M.
Publicada:
1 ene 2022
Resumen:
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 secondary MR following acute MI and compare the outcomes of those treated conservatively, surgically, and percutaneously Methods Retrospective international registry of consecutive patients with at least moderate-to-severe MR following MI treated and results in 21 centres 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 edge-to-edge repair. The primary endpoint was in-hospital mortality. A total of 471 patients were included (43% female, age 73 ± 11 years): 205 underwent interventions, of whom 106 were SMVR and 99 PMVR. Patients who underwent mitral valve intervention were in a worse clinical state (Killip class >_3 in 60% vs. 43%, P < 0.01), but yet had lower in-hospital and 1-year mortality compared with those treated conservatively [11% vs. 27%, P < 0.01 and 16% vs. 35%, P < 0.01; adjusted hazard ratio (HR) 0.28, 95% confidence interval (CI) 0.18–0.46, P < 0.01]. Surgical mitral valve repair or replacement was performed earlier than PMVR [median of 12 days from MI date (interquartile range 5–19) vs. 19 days (10–40), P < 0.01]. The immediate procedural success did not differ between SMVR and PMVR (92% vs. 93%, P = 0.53). However, in-hospital and 1-year mortality rates were significantly higher in SMVR than in PMVR (16% vs. 6%, P = 0.03 and 31% vs. 17%, P = 0.04; adjusted HR 3.75, 95% CI 1.55–9.07, P < 0.01). Conclusions Early intervention may mitigate the poor prognosis associated with conservative therapy in patients with post-MI MR. Percutaneous mitral valve repair can serve as an alternative for surgery in reducing MR for high-risk patients. © 2022 Oxford University Press. All rights reserved.
Filiaciones:
Haberman D.:
Heart Center, Kaplan Medical Center, 1, Pasternak Street, Rehovot, 7661041, Israel
Hebrew University of Jerusalem,, The Faculty of Medicine,, Jerusalem, Israel
Estévez-Loureiro R.:
Interventional Cardiology Unit, Hospital Álvaro Cunqueiro, Estrada de Clara Campoamor, 341, Vigo, 36213, Spain
Benito-Gonzalez T.:
Department of Cardiology, University Hospital of Leon, C/ ALTOS DE NAVA, S/N, Leon, 24071, Spain
Denti P.:
Cardiochirurgia IRCCS Ospedale San Raffaele, Via Olgettina, 60, Milano, 20132, Italy
Arzamendi D.:
Interventional Cardiology Unit, Hospital Sant Pau i Santa Creu, Carrer de Sant Quintí, 89, Barcelona, 08041, Spain
Adamo M.:
Cardiac Catheterization Laboratory, ASST Spedali Civili di Brescia, Piazzale Spedali Civili, 1, Brescia, 25123, Italy
Freixa X.:
Interventional Cardiology Unit, Hospital Clinic, C.de Villarroel, Barcelona, 170, Spain
Nombela-Franco L.:
Cardiovascular Institute, Hospital Clínico San Carlos, Instituto de Investigacion Sanitaria San Carlos, IdISSC, Calle del Prof Martín Lagos, s/n, Madrid, 28040, Spain
Villablanca P.:
Interventional Cardiology, The Center for Structural Heart Disease, Henry Ford Hospital, 2799 West Grand Blvd., Detroit, MI, United States
Krivoshei L.:
Department of cardiology, Kantonsspital Liestal, Rheinstrasse 26, Liestal, 4410, Switzerland
Fam N.:
Division of Cardiology, St. Michael’s Hospital, University of Toronto, 36 Queen St E, Toronto, ON M5B 1W8, Canada
Spargias K.:
Department of Transcatheter Heart Valves, HYGEIA Hospital, Erithrou Stavrou 4, Marousi 151 23, Athens, Greece
Czarnecki A.:
Schulich Heart Centre, Sunnybrook Health Sciences Centre, University of Toronto, Hospital RoadON M4N 3M5, Canada
Pascual I.:
Department of Cardiology, Hospital Universitario Central de Asturias, Av. Roma, Oviedo, 33011, Spain
Praz F.:
Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 18, Bern, 3010, Switzerland
Sudarsky D.:
Cardiovascular Institute, Baruch Padeh Medical Center, Poriya, Dov Hoz 0, Tiberias, Israel
Kerner A.:
Department of Cardiology, Rambam Medical Center, B. Rappaport Faculty of Medicine, Technion Medical School, Efron St 1, Haifa, 35254, Israel
Ninios V.:
Department of Cardiology, Interbalkan European Medical Center, Asklipiou 10, Pilea, Thessaloniki, 55535, Greece
Gennari M.:
IRCCS Centro Cardiologico Monzino, Department of Cardiovascular Surgery, Via Carlo Parea, 4, Milan, 20138, Italy
HerzZentrum Hirslanden Zürich, Witellikerstrasse 36, Zurich, 8008, Switzerland
Beeri R.:
Heart Institute, Hadassah-Hebrew University Medical Center, Kalman Ya’akov Man St, Jerusalem, 9755506, Israel
Perl L.:
Cardiology Department, Rabin Medical Center, The, Sackler’ Faculty of Medicine, Tel Aviv University, Zeev Jabotinsky St 39, Petah Tikva, 49100, Israel
Wasserstrum Y.:
Leviev Heart Center, Sheba Medical Center & Sackler School of Medicine, Tel Aviv University, Derech Sheba 2, Ramat Gan, Tel Aviv, Israel
Danenberg H.:
Heart Institute, Hadassah-Hebrew University Medical Center, Kalman Ya’akov Man St, Jerusalem, 9755506, Israel
Poles L.:
Heart Center, Kaplan Medical Center, 1, Pasternak Street, Rehovot, 7661041, Israel
George J.:
Heart Center, Kaplan Medical Center, 1, Pasternak Street, Rehovot, 7661041, Israel
Caneiro-Queija B.:
Interventional Cardiology Unit, Hospital Álvaro Cunqueiro, Estrada de Clara Campoamor, 341, Vigo, 36213, Spain
Scianna S.:
HerzZentrum Hirslanden Zürich, Witellikerstrasse 36, Zurich, 8008, Switzerland
Moaraf I.:
Kantonsspital Baden, Department of Cardiology, Im Ergel 1, Baden, 5404, Switzerland
Schiavi D.:
Cardiochirurgia IRCCS Ospedale San Raffaele, Via Olgettina, 60, Milano, 20132, Italy
Scardino C.:
Department of Cardiology, Joan XXIII University Hospital, C/ Dr. Mallafrè Guasch, 4, Tarragona, 43005, Spain
Corpataux N.:
Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 18, Bern, 3010, Switzerland
Echarte-Morales J.:
Department of Cardiology, University Hospital of Leon, C/ ALTOS DE NAVA, S/N, Leon, 24071, Spain
Chrissoheris M.:
Department of Transcatheter Heart Valves, HYGEIA Hospital, Erithrou Stavrou 4, Marousi 151 23, Athens, Greece
Fernández-Peregrina E.:
Interventional Cardiology Unit, Hospital Sant Pau i Santa Creu, Carrer de Sant Quintí, 89, Barcelona, 08041, Spain
Pasquale M.D.:
Cardiac Catheterization Laboratory, ASST Spedali Civili di Brescia, Piazzale Spedali Civili, 1, Brescia, 25123, Italy
Regueiro A.:
Interventional Cardiology Unit, Hospital Clinic, C.de Villarroel, Barcelona, 170, Spain
Vergara-Uzcategui C.:
Cardiovascular Institute, Hospital Clínico San Carlos, Instituto de Investigacion Sanitaria San Carlos, IdISSC, Calle del Prof Martín Lagos, s/n, Madrid, 28040, Spain
Iñiguez-Romo A.:
Interventional Cardiology Unit, Hospital Álvaro Cunqueiro, Estrada de Clara Campoamor, 341, Vigo, 36213, Spain
Fernández-Vázquez F.:
Department of Cardiology, University Hospital of Leon, C/ ALTOS DE NAVA, S/N, Leon, 24071, Spain
Dvir D.:
Jesselson Integrated Heart Centre, Shaare Zedek Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, 12, Shmu’el Bait, POB 3235, Jerusalem, 9103102, Israel
Maisano F.:
Cardiochirurgia IRCCS Ospedale San Raffaele, Via Olgettina, 60, Milano, 20132, Italy
Taramasso M.:
HerzZentrum Hirslanden Zürich, Witellikerstrasse 36, Zurich, 8008, Switzerland
Shuvy M.:
Heart Institute, Hadassah-Hebrew University Medical Center, Kalman Ya’akov Man St, Jerusalem, 9755506, Israel
Jesselson Integrated Heart Centre, Shaare Zedek Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, 12, Shmu’el Bait, POB 3235, Jerusalem, 9103102, Israel
All Open Access; Bronze
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