Percutaneous valve repair may be best option for post-MI mitral regurgitation
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Despite similar procedural success, percutaneous mitral valve repair for post-MI mitral regurgitation was associated with lower in-hospital and 1-year mortality vs. surgical mitral valve repair or replacement, researchers reported.
In addition, post-MI mitral regurgitation treated surgically or with percutaneous mitral valve intervention was associated with better in-hospital and 1-year survival compared with conservative management, according to data published in the European Heart Journal.
“Previous literature is limited to a small case series, reporting that percutaneous mitral valve repair using the MitraClip (Abbott) device after MI complicated by severe mitral regurgitation is safe and effective,” Dan Haberman, MD, cardiology fellow in the Heart Center at Kaplan Medical Center in Rehovot, Israel, and colleagues wrote. “We aimed to collect the largest experience worldwide of acute mitral regurgitation following MI treated with percutaneous mitral valve repair and compare the characteristics and outcomes of such patients with patients treated surgically or conservatively.”
To this end, researchers utilized data from the IREMMI registry to identify 471 consecutive patients with moderate to severe mitral regurgitation following MI treated at 21 international centers. Of the 471 patients included (mean age, 73 years; 43% women), 205 underwent interventions (106 surgical mitral valve repair or replacement; 99 percutaneous mitral valve repair). The primary endpoint was in-hospital mortality.
Researchers observed that, although more patients who underwent mitral valve intervention presented in severe clinical condition compared with those who received conservative management (Killip class 3 or more, 60% vs. 43%; P < .01), those who received conservative treatment experienced greater risk for in-hospital mortality (OR = 4.52; 95% CI, 2.38-8.6; P < .01) and 1-year mortality (adjusted HR = 3.53; 95% CI, 2.18-5.73; P < .01).
Haberman and colleagues noted that surgical mitral valve intervention was performed sooner after MI compared with percutaneous intervention (median, 12 vs. 19 days; P < .01).
Despite similar procedural success between surgical and percutaneous mitral valve interventions (92% vs. 93%; P = .53), both in-hospital (16% vs. 6%; P = .03) and 1-year mortality (31% vs. 17%; P = .04) were greater among those who underwent surgical mitral valve repair or replacement compared with percutaneous mitral valve replacement (aHR for overall mortality = 3.75; 95% CI, 1.55-9.07; P < .01).
When researchers excluded patients who died in-hospital, they observed no significant difference in 1-year mortality between surgical and percutaneous mitral valve intervention (P for log-rank = .44).
“Patients who were treated conservatively had the worst prognosis. Mitral valve interventions, both percutaneous and surgical, had high success rates and were associated with better survival outcomes than conservative therapy,” the researchers wrote. “Nevertheless, patients who underwent surgical mitral valve repair had high perioperative mortality, and more than 15% died during hospitalization. Our findings suggest that percutaneous mitral valve repair can serve as an alternative for surgery in reducing mitral regurgitation for high-risk patients with significant post-MI mitral regurgitation.”
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