急性心肌梗死后严重二尖瓣反流的经导管边缘到边缘修复——基于病因学的分析

IF 16.9 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

European Journal of Heart Failure Pub Date : 2025-01-15 DOI:10.1002/ejhf.3582

Dan Haberman, Rodrigo Estévez‐Loureiro, Andrew Czarnecki, Francesco Melillo, Marianna Adamo, Pedro Villablanca, Doron Sudarsky, Fabien Praz, Leor Perl, Xavier Freixa, Andrea Scotti, Paul Fefer, Konstantinos Spargias, Neil Fam, Lisa Manevich, Giulia Masiero, Luis Nombela‐Franco, Isaac Pascual, Gabriele Crimi, Vlasis Ninios, Ronen Beeri, Tomas Benito‐Gonzalez, Dabit Arzamendi, Estefanıa Fernández‐Peregrina, Francesco Giannini, Antonio Mangieri, Lion Poles, Jacob George, Julio Cesar Echarte Morales, Berenice Caneiro‐Queija, Paolo Denti, Davide Schiavi, Azeem Latib, Michael Chrissoheris, Haim Danenberg, Giuseppe Tarantini, Danny Dvir, Francesco Maisano, Maurizio Taramasso, Mony Shuvy

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引用次数: 0

摘要

目的评估急性心肌梗死（MI）后明显二尖瓣反流（MR）患者的经导管边缘到边缘修复（TEER）与预后之间的关系，重点研究高危手术患者急性心肌梗死后MR的病因。方法和结果MitraClip在急性心肌梗死后急性二尖瓣反流（IREMMI）中的国际注册包括187例使用TEER治疗的严重MR - MI后患者。其中176例纳入分析，急性乳头肌破裂（PMR） 23例（13%），急性继发性mr 153例（87%），平均年龄70±10岁，女性占41%。PMR患者心血管危险因素较少：高血压（52% vs. 73%, p = 0.04），糖尿病(26% vs. 48%, p <；0.01)，但左室射血分数较高(45±15% vs.35±10%,p <；0.01)。PMR患者更容易出现心源性休克（91% vs. 51%, p = 0.001），需要机械循环支持（74% vs. 34%, p = 0.01），并且EuroSCORE II更高（23±13% vs. 13±11%,p = 0.011）。PMR从MI到TEER的中位时间（6天）短于继发MR（20天）(p <；0.01)。手术成功率相似（87% vs. 92%, p = 0.49）， MR等级降低相似。然而，PMR患者的住院死亡率（校正优势比[OR] 3.05, 95%可信区间[CI] 1.15-8.12, p = 0.02）、30天死亡率（未校正优势比[OR] 3.99, 95% CI 1.42-11.26, p = 0.01）和转行二尖瓣置换术的比率(22%对3%，p <；0.01)(未经调整OR 8.17, 95% CI 2.15-30.96, p <；0.001)。磁共振的病因、心源性休克和手术时机对住院死亡率有显著影响。在调整EuroSCORE II和心源性休克后，MR病因学仍然是最强的预测因子(调整OR为6.71；95% CI 2.06-21.86, p <；0.01)。结论：对于两种病因的失代偿性心肌梗死后MR患者，经导管边缘到边缘修复可被视为一种补救性或桥接性手术；然而，PMR患者有更高的死亡率和转行手术的风险。

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Transcatheter edge‐to‐edge repair in severe mitral regurgitation following acute myocardial infarction – aetiology‐based analysis

AimsTo evaluate the association between transcatheter edge‐to‐edge repair (TEER) and outcomes in patients with significant mitral regurgitation (MR) following acute myocardial infarction (MI), focusing on the aetiology of acute post‐MI MR in high‐risk surgical patients.Methods and resultsThe International Registry of MitraClip in Acute Mitral Regurgitation following Acute Myocardial Infarction (IREMMI) includes 187 patients with severe MR post‐MI managed with TEER. Of these, 176 were included in the analysis, 23 (13%) patients had acute papillary muscle rupture (PMR) and 153 (87%) acute secondary MR. The mean age was 70 ± 10 years and 41% were female. PMR patients had fewer cardiovascular risk factors: hypertension (52% vs. 73%, p = 0.04), diabetes (26% vs. 48%, p < 0.01) but a higher left ventricular ejection fraction (45± 15% vs.35± 10%, p < 0.01) compared secondary MR patients. PMR patients were more likely to present in cardiogenic shock (91% vs. 51%, p = 0.001), require mechanical circulatory support (74% vs. 34%, p = 0.01), and had a higher EuroSCORE II (23± 13% vs. 13± 11%, p = 0.011). The median time from MI to TEER was shorter in PMR (6 days) versus secondary MR (20 days) (p < 0.01). Procedural success was similar (87% vs. 92%, p = 0.49) with comparable MR grade reduction. However, PMR patients had significantly higher in‐hospital mortality rates (adjusted odds ratio [OR] 3.05, 95% confidence interval [CI] 1.15–8.12, p = 0.02), 30‐day mortality rates (unadjusted OR 3.99, 95% CI 1.42–11.26, p = 0.01) and a higher rate of conversion to surgical mitral valve replacement (22% vs. 3%, p < 0.01) (unadjusted OR 8.17, 95% CI 2.15–30.96, p < 0.001). Aetiology of MR, cardiogenic shock, and procedure timing significantly impacted in‐hospital mortality. After adjusting for EuroSCORE II and cardiogenic shock, MR aetiology remained the strongest predictor (adjusted OR 6.71; 95% CI 2.06–21.86, p < 0.01).ConclusionTranscatheter edge‐to‐edge repair may be considered a salvage or bridge procedure in decompensated post‐MI MR patients of both aetiologies; however, patients with PMR have a higher risk of mortality and conversion to surgery.

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来源期刊

European Journal of Heart Failure 医学-心血管系统

CiteScore

27.30

自引率

11.50%

发文量

365

审稿时长

1 months

期刊介绍： European Journal of Heart Failure is an international journal dedicated to advancing knowledge in the field of heart failure management. The journal publishes reviews and editorials aimed at improving understanding, prevention, investigation, and treatment of heart failure. It covers various disciplines such as molecular and cellular biology, pathology, physiology, electrophysiology, pharmacology, clinical sciences, social sciences, and population sciences. The journal welcomes submissions of manuscripts on basic, clinical, and population sciences, as well as original contributions on nursing, care of the elderly, primary care, health economics, and other related specialist fields. It is published monthly and has a readership that includes cardiologists, emergency room physicians, intensivists, internists, general physicians, cardiac nurses, diabetologists, epidemiologists, basic scientists focusing on cardiovascular research, and those working in rehabilitation. The journal is abstracted and indexed in various databases such as Academic Search, Embase, MEDLINE/PubMed, and Science Citation Index.