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)
Por:
Estevez-Loureiro, R, Shuvy, M, Taramasso, M, Benito-Gonzalez, T, Denti, P, Arzamendi, D, Adamo, M, Freixa, X, Villablanca, P, Krivoshei, L, Fam, N, Spargias, K, Czarnecki, A, Haberman, D, Agmon, Y, Sudarsky, D, Pascual, I, Ninios, V, Scianna, S, Moaraf, I, Schiavi, D, Chrissoheris, M, Beeri, R, Kerner, A, Fernandez-Peregrina, E, Di Pasquale, M, Regueiro, A, Poles, L, Iniguez-Romo, A, Fernandez-Vazquez, F, Maisano, F
Publicada:
1 may 2021
Ahead of Print:
1 feb 2021
Resumen:
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.
Filiaciones:
Estevez-Loureiro, R:
Hosp Alvaro Cunqueiro, Intervent Cardiol Unit, Vigo, Spain
Shuvy, M:
Hadassah Hebrew Univ, Heart Inst, Med Ctr, Jerusalem, Israel
Taramasso, M:
Univ Hosp Zurich, Heart Valve Clin, Zurich, Switzerland
Benito-Gonzalez, T:
Complejo Asistencial Univ Leon, Intervent Cardiol Unit, Leon, Spain
Denti, P:
San Raffaele Univ Hosp, Dept Cardiovasc Surg, Milan, Italy
Arzamendi, D:
Hosp St Pau & Santa Creu, Intervent Cardiol Unit, Barcelona, Spain
Adamo, M:
Spedali Civili Brescia, Cardiac Catheterizat Lab, Cardiothorac Dept, Brescia, Italy
Freixa, X:
Hosp Clin Barcelona, Intervent Cardiol Unit, Barcelona, Spain
Villablanca, P:
Henry Ford Hosp, Ctr Struct Heart Dis, Intervent Cardiol, Struct Heart Dis Intervent,Endovasc Intervent, Detroit, MI 48202 USA
Krivoshei, L:
Kantonsspital Baden, Dept Cardiol, Baden, Switzerland
Fam, N:
Univ Toronto, Div Cardiol, St Michaels Hosp, Toronto, ON, Canada
Spargias, K:
HYGEIA Hosp, Dept Transcatheter Heart Valves, Athens, Greece
Czarnecki, A:
Univ Toronto, Sunnybrook Heath Sci Ctr, Shulich Heart Ctr, Div Cardiol, Tronto, ON, Canada
Haberman, D:
Hebrew Univ Jerusalem, Heart Ctr, Kaplan Med Ctr, Jerusalem, Israel
Agmon, Y:
Technion Med Sch, Rambam Med Ctr, Dept Cardiol, Haifa, Israel
Technion Med Sch, B Rappaport Fac Med, Haifa, Israel
Sudarsky, D:
Padeh Med Ctr, Cardiovasc Inst, Tiberias, Israel
Pascual, I:
Hosp Univ Cent Asturias, Intervent Cardiol Unit, Oviedo, Spain
Ninios, V:
Interbalkan European Med Ctr, Dept Cardiol, Thessaloniki, Greece
Scianna, S:
Univ Hosp Zurich, Heart Valve Clin, Zurich, Switzerland
Moaraf, I:
Kantonsspital Baden, Dept Cardiol, Baden, Switzerland
Schiavi, D:
San Raffaele Univ Hosp, Dept Cardiovasc Surg, Milan, Italy
Chrissoheris, M:
HYGEIA Hosp, Dept Transcatheter Heart Valves, Athens, Greece
Beeri, R:
Hadassah Hebrew Univ, Heart Inst, Med Ctr, Jerusalem, Israel
Kerner, A:
Technion Med Sch, Rambam Med Ctr, Dept Cardiol, Haifa, Israel
Technion Med Sch, B Rappaport Fac Med, Haifa, Israel
Fernandez-Peregrina, E:
Hosp St Pau & Santa Creu, Intervent Cardiol Unit, Barcelona, Spain
Di Pasquale, M:
Spedali Civili Brescia, Cardiac Catheterizat Lab, Cardiothorac Dept, Brescia, Italy
Regueiro, A:
Hosp Clin Barcelona, Intervent Cardiol Unit, Barcelona, Spain
Poles, L:
Hebrew Univ Jerusalem, Heart Ctr, Kaplan Med Ctr, Jerusalem, Israel
Iniguez-Romo, A:
Hosp Alvaro Cunqueiro, Intervent Cardiol Unit, Vigo, Spain
Fernandez-Vazquez, F:
Complejo Asistencial Univ Leon, Intervent Cardiol Unit, Leon, Spain
Maisano, F:
Univ Hosp Zurich, Heart Valve Clin, Zurich, Switzerland
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