MitraClip is safe and effective in patients with acute mitral regurgitation with myocardial infarction with and without cardiogenic shock, according to results of a registry analysis presented Saturday at the TCT Connect virtual conference.
Rodrigo Estevez-Loureiro, MD, PhD, of University Hospital Alvaro Cunqueiro, Vigo, Spain, presented the IREMMI registry (International REgisty MitraClip in acute Myocardial Infarction) results Saturday at the TCT Connect virtual conference.
Severe mitral regurgitation (MR) after acute myocardial infarction (MI) is associated with high mortality, up to 50%. Traditionally, surgery has been the only alternative to medical therapy. Studies on MitraClip (Abbott) in acute MR with and without cardiogenic shock are lacking.
In the IREMMI registry, the authors identified all consecutive patients with acute MR following myocardial infarction who underwent percutaneous mitral valve repair (PMVR) from 18 centers in eight countries between January 2016 and March 2020 and compared patients with and without cardiogenic shock (CS). CS was defined by Society of Cardiovascular Angiography and Interventions (SCAI) recommendations.
A total of 50 patients had MitraClip implanted for acute MR with CS, and 43 patients underwent PMVR without CS. The patients’ mean age was 70 years, and 52% were women. Patients with CS tended to be younger, with lower left ventricular ejection fraction and higher surgical risk.
Technical success rate was 100% and procedural success was 90% in the group of patients with CS. Procedural time was significantly higher in the CS group.
Major complications after the procedure did not differ between groups. At 3 months, MR grade ≤2+ was noted in 83.4% in CS and 90.6% in non-CS patients (p=0.348). New York Heart Association (NYHA) functional class did not differ between the groups at 3-month follow-up. At 7-month follow-up, overall mortality (16% CS vs. 9.3% non-CS, p=0.37) AND rehospitalization due to heart failure (28% CS vs. 25.6% non-CS, p=0.79) did not differ between the groups. In regression analysis, CS was not associated with any mortality or readmission for heart failure.
Estevez-Loureiro concluded that in this very high-risk population, PMVR is safe and effective, with acceptable rates of mortality and hospitalization for heart failure. He added that the development of CS should not preclude PMVR with MitraClip.