TY - JOUR
T1 - Conservative, surgical, and percutaneous treatment for mitral regurgitation shortly after acute myocardial infarction
AU - Haberman, Dan
AU - Estévez-Loureiro, Rodrigo
AU - Benito-Gonzalez, Tomas
AU - Denti, Paolo
AU - Arzamendi, Dabit
AU - Adamo, Marianna
AU - Freixa, Xavier
AU - Nombela-Franco, Luis
AU - Villablanca, Pedro
AU - Krivoshei, Lian
AU - Fam, Neil
AU - Spargias, Konstantinos
AU - Czarnecki, Andrew
AU - Pascual, Isaac
AU - Praz, Fabien
AU - Sudarsky, Doron
AU - Kerner, Arthur
AU - Ninios, Vlasis
AU - Gennari, Marco
AU - Beeri, Ronen
AU - Perl, Leor
AU - Wasserstrum, Yishay
AU - Danenberg, Haim
AU - Poles, Lion
AU - George, Jacob
AU - Caneiro-Queija, Berenice
AU - Scianna, Salvatore
AU - Moaraf, Igal
AU - Schiavi, Davide
AU - Scardino, Claudia
AU - Corpataux, Noé
AU - Echarte-Morales, Julio
AU - Chrissoheris, Michael
AU - Fernández-Peregrina, Estefanía
AU - Pasquale, Mattia Di
AU - Regueiro, Ander
AU - Vergara-Uzcategui, Carlos
AU - Iñiguez-Romo, Andres
AU - Fernández-Vázquez, Felipe
AU - Dvir, Danny
AU - Maisano, Francesco
AU - Taramasso, Maurizio
AU - Shuvy, Mony
N1 - Publisher Copyright:
© 2022 Oxford University Press. All rights reserved.
PY - 2022/2/12
Y1 - 2022/2/12
N2 - 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.
AB - 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.
KW - Mitral regurgitation
KW - Mitral valve surgery
KW - Myocardial infarction
KW - Percutaneous edge-to-edge repair
UR - https://www.scopus.com/pages/publications/85124633196
U2 - 10.1093/eurheartj/ehab496
DO - 10.1093/eurheartj/ehab496
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C2 - 34463727
AN - SCOPUS:85124633196
SN - 0195-668X
VL - 43
SP - 641
EP - 650
JO - European Heart Journal
JF - European Heart Journal
IS - 7
ER -