Cardiogenic shock (CS) is associated with a high morbidity and mortality rate when there is significant mitral regurgitation. This study was conducted to evaluate the clinical characteristics and results of patients with CS who underwent transcatheter edge-to-edge repair (TEER) with the MitraClip. In addition, in this cohort, the clinical outcomes of individuals with and without acute myocardial infarction (AMI) were compared.

Methodology:

Patients with CS who received an urgent MitraClip operation between January 2014 and December 2018 were included in the study using the NRD (Nationwide Readmission Database). Patients were divided into two groups based on whether or not they had an AMI. In-hospital mortality was the primary endpoint, while 30-day readmission was the secondary outcome of the study.

Results:

For this study, a total of 639 patients with an average age of 73 years were identified. Of the total study population, 59.9% were male. One-hundred-seventy-nine patients (28%) had AMI, while the remaining 460 patients (72%) did not. Both groups had a median age of 73 years at MitraClip.

Patients with AMI were more likely than the non-AMI patients to require mechanical circulatory support (MCS) (60.3% vs 25.7%; P< 0.001) and have a history of coronary artery disease (74.3% vs 52.2%; P < 0.001). In addition, they were less likely to have atrial fibrillation (AF) (44.1% vs 62%; P<0.001). Of the total in-hospital mortality (n=147 patients, 23%) that occurred, the rate was higher among AMI patients than non-AMI patients. In multivariable analyses that included baseline clinical variables, older age, MCS use, obesity, and end-stage renal disease were found to be predictors of in-hospital mortality in the entire study population. Patients aged 75 to 84 years had the greatest in-hospital mortality rates in both the AMI and non-AMI groups, whereas patients aged 65 years had the lowest in-hospital mortality rates. At the 30-day follow-up, 113 patients (26.3%) were readmitted, with similar readmission rates in patients with and without AMI (26.1 % vs 26.3 %, respectively; P =1).

Conclusion:

The study's findings revealed that age is a significant predictor of in-hospital death among patients who underwent transcatheter edge-to-edge repair (TEER). The mortality rate was higher in patients with AMI than those without AMI.

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Keywords

Disease Condition,Therapeutic Modality,Myocardial Disease and Cardiomyopathies,Interventional Cardiology,Cardiogeic Shock,Trans catheter Therapy

Source

https://www.jacc.org/doi/10.1016/j.jcin.2021.04.052

Tags

Disease Condition ,Therapeutic Modality ,Myocardial Disease and Cardiomyopathies,Interventional Cardiology,Cardiogenic Shock,Trans catheter Therapy