Bellamkonda, Pallavi

Background: Severe mitral regurgitation (MR) in cardiogenic shock (CS) presents unique therapeutic challenges, especially in patients with prohibitive surgical risk. Transcatheter edge-to-edge repair (TEER) with MitraClip offers a less invasive alternative, yet optimal strategies for hemodynamic support in this setting remain unclear. Methods: We conducted a retrospective study of patients undergoing MitraClip implantation for severe MR and CS between 2018 and 2024 at a tertiary academic center. Of 440 screened cases, 47 met CS criteria and were stratified based on receipt of periprocedural Impella support. Clinical, procedural, and survival outcomes were compared between Impella-supported and unsupported cohorts using appropriate statistical methods. Results: Among the 47 patients, 24 received Impella support and 23 did not. The Impella group had greater illness severity, including higher rates of preprocedural intubation (75.0% vs. 43.5%) and SCAI stage D shock (50.0% vs. 13.0%). Despite these differences, procedural success was 100% in both groups. In-hospital (8.3% vs. 8.7%), 30-day (12.5% vs. 8.7%), and 1-year mortality (25.0% vs. 26.0%) were similar between Impella and non-Impella patients, respectively. Impella recipients had longer hospital stays (median 18 vs. 11 days; p=0.032) and higher 1-year readmission rates (55.0% vs. 21.7%; p=0.024), reflecting baseline acuity. There were no differences in major procedural complications or re-intervention rates. Conclusions: MitraClip implantation in CS patients supported with Impella is feasible and safe. Despite significantly worse hemodynamic profiles, outcomes were comparable to those without mechanical support. These findings suggest a potential role for tailored Impella use in expanding TEER to critically ill patients and underscore the need for prospective studies to guide support strategies in high-risk MR intervention.

Introduction: Acute myocardial infarction (AMI) remains a leading cause of morbidity and mortality worldwide. In the quest for improved therapeutic strategies, the addition of Sodium Glucose Transporter Inhibitors (SGLTis) to the treatment regimen has garnered considerable attention. This meta-analysis endeavors to shed light on the efficacy of SGLTis in short-term cardio-renal protection post-AMI. By synthesizing evidence from diverse studies. Methods: Adhering to the PRISMA guidelines, a meticulous systematic review and meta-analysis were conducted. Comprehensive literature searches across PubMed, Web of Science, Scopes, and Google Scholar were performed. Inclusion criteria comprised four Randomized Controlled Trials (RCTs), one retrospective cohort, and one observational study, investigating the effects of SGLTis versus placebo on AMI patients, irrespective of diabetic status. Our analysis included the following outcomes: acute kidney injury, all-cause death, cardiovascular mortality, cardiac death, composite of cardiovascular death/hospitalization for heart failure, and NT-proBNP levels. Results: Our analysis encompassed six scientific articles involving 7238 patients. SGLTIs exhibited a notable favorable effect solely on acute kidney injury (P value=0.001, 95% CI [0.46-0.82]). Conversely, no significant benefit was observed in other short-term outcomes, including all-cause death, cardiovascular mortality, cardiac death, composite of cardiovascular death/hospitalization for heart failure, and NT-proBNP levels. These results align with previous studies suggesting the renal protective effects of SGLTIs but highlight the need for further research to clarify their overall cardiovascular benefits in AMI patients. Conclusion: Incorporating SGLTis into the therapeutic armamentarium of AMI patients, irrespective of diabetic status, demonstrated a discernible advantage solely concerning acute kidney injury. However, no appreciable benefit was discerned across other assessed metrics. These findings underscore the need for further exploration and tailored therapeutic strategies in the management of post-AMI patients.