Key result
Pre-MitraClip cardiogenic shock in acute post-AMI MR is not linked to higher mortality or HF readmission.
Why the study?
Acute MR after AMI can lead to CS and is associated with high mortality, prompting evaluation of MitraClip outcomes according to CS status.
Does cardiogenic shock worsen mortality and heart failure rehospitalization in patients with acute MR following AMI undergoing PMVR with MitraClip?
Observational (n=93)
Yes
Does cardiogenic shock worsen mortality and heart failure rehospitalization in patients with acute MR following AMI undergoing PMVR with MitraClip?
Hazard Ratio: 1.1 (95% CI 0.3–4.6)
Absolute Event Rate: 28% vs 25.6%
p-value: p=0.889
In patients with acute MR following AMI treated with MitraClip, clinical outcomes were similar regardless of whether they presented with cardiogenic shock, provided initial hemodynamic stabilization was achieved.
MitraClip yields comparable short-term outcomes in stabilized post-AMI MR patients with or without CS; leaves open randomized confirmation of survival benefit.
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.
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Estévez‐Loureiro et al. (2021) conducted an observational in Acute mitral regurgitation following acute myocardial infarction (n=93). Cardiogenic shock vs. No cardiogenic shock (non-CS) was evaluated on Combined event mortality or rehospitalization due to heart failure (HR 1.1, 95% CI 0.3-4.6, p=0.889). Cardiogenic shock prior to MitraClip repair for acute MR post-AMI was not associated with increased mortality or heart failure rehospitalization (HR 1.1; 95% CI 0.3-4.6; p=0.889).
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