Rodrigo Estévez-Loureiro1, Mony Shuvy2, Maurizio Taramasso3, Tomas Benito-Gonzalez4, Paolo Denti5, Dabit Arzamendi6, Marianna Adamo7, Xavier Freixa8, Pedro Villablanca9, Lian Krivoshei10, Neil Fam11, Konstantinos Spargias12, Andrew Czarnecki13, Dan Haberman14, Yoram Agmon15, Doron Sudarsky16, Isaac Pascual17, Vlasis Ninios18, Salvatore Scianna3, Igal Moaraf10, Davide Schiavi5, Michael Chrissoheris12, Ronen Beeri2, Arthur Kerner15, Estefanía Fernández-Peregrina6, Mattia Di Pasquale7, Ander Regueiro8, Lion Poles14, Andres Iñiguez-Romo1, Felipe Fernández-Vázquez4, Francesco Maisano3. 1. Interventional Cardiology Unit, Hospital Álvaro Cunqueiro, Vigo, Spain. 2. Heart Institute, Hadassah-Hebrew University Medical Center, Jerusalem, Israel. 3. Heart Valve Clinic, University Hospital of Zurich, Zurich, Switzerland. 4. Interventional Cardiology Unit, Complejo Asistencial Universitario de Leon, Leon, Spain. 5. Department of Cardiovascular Surgery, San Raffaele University Hospital, Milan, Italy. 6. Interventional Cardiology Unit, Hospital Sant Pau i Santa Creu, Barcelona, Spain. 7. Cardiac Catheterization Laboratory, Cardiothoracic Department, Spedali Civili Brescia, Brescia, Italy. 8. Interventional Cardiology Unit, Hospital Clinic, Barcelona, Spain. 9. Interventional Cardiology, Structural Heart Disease Interventions, Endovascular Interventions, The Center for Structural Heart Disease, Henry Ford Hospital, Detroit, Michigan, USA. 10. Department of Cardiology, Kantonsspital Baden, Baden, Switzerland. 11. Division of Cardiology, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada. 12. Department of Transcatheter Heart Valves, HYGEIA Hospital, Athens, Greece. 13. Division of Cardiology, Sunnybrook Heath Sciences Centre, University of Toronto, Shulich Heart Centre, Tronto, Ontario, Canada. 14. Heart Center, Kaplan Medical Center, Affiliated to the Hebrew University, Jerusalem, Israel. 15. Department of Cardiology, Rambam Medical Center, and B. Rappaport Faculty of Medicine, Technion Medical School, Haifa, Israel. 16. Cardiovascular Institute, Padeh Medical Center, Tiberias, Israel. 17. Interventional Cardiology Unit, Hospital Universitario Central de Asturias, Oviedo, Spain. 18. Department of Cardiology, Interbalkan European Medical Center, Thessaloniki, Greece.
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.
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.
Authors: Leor Perl; Tamir Bental; Katia Orvin; Hana Vaknin-Assa; Gabriel Greenberg; Pablo Codner; Yaron Shapira; Mordehay Vaturi; Alexander Sagie; Ran Kornowski Journal: Front Cardiovasc Med Date: 2022-01-13
Authors: Rodrigo Estévez-Loureiro; Marta Tavares Da Silva; José Antonio Baz-Alonso; Berenice Caneiro-Queija; Manuel Barreiro-Pérez; Francisco Calvo-Iglesias; Rocio González-Ferreiro; Luis Puga; Miguel Piñón; Andrés Íñiguez-Romo Journal: Front Cardiovasc Med Date: 2022-09-23