IREMMI: Outcomes of MitraClip in patients with acute mitral regurgitation in AMI with and without cardiogenic shock
Reported from the TCT Congress 2020
At TCT Connect 2020, Rodrigo Estevez-Loureiro presented the results of the IREMMI trial. Nicole Karam provides a summary of the key messages.
Acute mitral regurgitation (MR) may develop in the setting of an acute myocardial infarction (AMI) is a severe complication, associated with a worse prognosis when persisting after percutaneous myocardial reperfusion. Surgical mitral repair often carries a high, and even prohibitive, procedural risk. Transcatheter mitral valve repair (TMVr) could be an interesting alternative, allowing mitral repair with a lower risk.
Despite few reports on the use of MitraClip® in this indication, the actual yield of TMVr in this setting remains uncertain. In the IREMMI study presented by Rodrigo Estevez-Loureiro at TCT 2020, the authors assessed the outcomes of MitraClip® in patients with acute MR in AMI with and without cardiogenic shock.
The methodology
Data were taken from a registry including all consecutive patients with AMI complicated by acute MR following at 18 centres in Europe, North America and Israel between January 2016 and March 2020. All patients were considered non-surgical candidates and treated with PMVR. The primary objectives were acute procedural success and clinical events, including heart failure-related death and readmissions. Outcomes were also compared between patients with and without cardiogenic shock.
What were the results?
Among 93 AMI patients included, 53% were in cardiogenic shock. Procedural success rate was >90%. Procedural time was longer in the cardiogenic shock group (143 vs. 8mn, P=0.003) even though there was no difference in terms of success and complications rate.
At 30-day follow-up, survival rate was 93.5% (10% in the cardiogenic shock vs. 2.3% in the non-cardiogenic shock group, P =0.212). At 3 months, mortality rate was 7.5%, again with significant difference between the groups; readmission rate for heart failure as 18%. Median follow-up was 7 months. There was no difference in mortality according to the presence of cardiogenic shock. The only mortality predictor as procedural success (HR 0.10; 95%CI 0.02;0.60; P=0.012).
My take on this study
The IREMMI study provides further evidence supporting the use of TMVr in patients who develop acute MR during AMI. While larger and randomized studies are needed to confirm the results, TMVr does seem to be a safe and promising treatment strategy for acute MR in the setting of STEMI, even when cardiogenic shock occurs.
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