Ischemic mitral regurgitation (IMR) has been associated with worse outcome myocardial
infarction. However, severity of mitral regurgitation (MR) and its impact on patients
with ST-elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary
intervention (PCI) remains unknown. We sought to determine impact of increasing severity
of IMR on outcomes in patients with STEMI undergoing primary PCI. All patients presenting
with STEMI who underwent primary PCI within 12 hours of symptoms from 1994 to 2014
were included. IMR was graded from 0 to 4+ within 3 days of index myocardial infarction
by echocardiography. Overall, 4,005 patients with STEMI were included. None, 1+, 2+,
3+, and 4+ MR were present in 3,200 (79.9%), 427 (10.7%), 260 (6.5%), 91 (2.3%), and
27 (0.7%) patients, respectively. On multivariate logistic regression analysis, more
severe MR was associated with older age, female gender, lower body mass index, anemia,
inferior STEMI, and longer door-to-balloon time. The 30-day mortality rates were 6.8%,
7.3%, 8.8%, 19.8%, and 26.1%, respectively, with increasing grade of MR. The 1-year
mortality rates were 10.8%, 12.4%, 20.8%, 37.4%, and 37.1%, whereas 5-year mortality
rates were 16.2%, 23.1%, 36.5%, 53.8%, and 63%, respectively (p <0.001 all), for none
to 4+ MR. After adjusting for age, gender, co-morbidities, ejection fraction, and
shock by multivariate analysis, severity of IMR was associated with incremental effect
on long-term mortality (hazard ratios of 1.42, 1.83, 2.41, and 2.95 for 1+ to 4+ MR
respectively, p <0.01 for all). In conclusion, higher grades of MR in patients with
STEMI undergoing primary PCI are associated with worse short- and long-term outcomes.
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Article info
Publication history
Published online: September 29, 2016
Accepted:
September 6,
2016
Received in revised form:
September 6,
2016
Received:
June 30,
2016
Footnotes
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© 2016 Published by Elsevier Inc.
