TCT-334 Ischemic Mitral Regurgitation Following ST-Elevation Myocardial Infarction: Temporal Trends Over a 20-Year Period

Background: Ischemic mitral regurgitation (IMR) is a common complication of acute ST-elevation myocardial infarction (STEMI). Little is known regarding the impact of IMR over a long period of follow up.Methods: Of 3,208 consecutive STEMI patients from a prospective registry, full echocardiographic information was available for 2,985 patients between the years 2000 and 2020. We compared the two decades- 2001 to 2010 and 2011 to 2020, and assessed for the presence of IMR at baseline, 3 (range 2–6) months and 12 (range 10–14) months after the index event.Results: One thousand six hundred and sixty six patients were included in the first decade, 1,319 in the second. Mean patient age was 61.3 ± 12.3 years, 21.1% female patients in the first decade vs. 60.9 ± 12.0 years and 22.2% female in the second (p = 0.40 and p = 0.212, respectively). Rates of moderate IMR or above during the index admission were 17.2% in the first period and 9.3% in the second one (p < 0.001). After 3 months, the rate of IMR was 48.5% for those who suffered from IMR at baseline, vs. 9.5% for those without IMR at baseline (HR- 4.2, p < 0.001). Death rates for those with moderate IMR or above were 14.7% and 17.8% after 1 and 2 years, respectively, vs. 7.3 and 9.6% for those without (p < 0.001 for both). IMR was associated with 1 year mortality in multivariate analysis (HR-1.37; 1.09–2.20, p = 0.009), as well as in propensity score matched analysis (HR 1.29; CI: 1.07–1.91; p < 0.001).Conclusions: IMR is a common complication following acute STEMI, impacting prognosis. Rates of IMR have declined significantly over the years.

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Impact of ischemic mitral regurgitation on left ventricle function in patients with ST elevation myocardial infarction treated with primary percutaneus interventions

European Journal of Heart Failure Supplements ◽

10.1016/s1567-4215(08)60131-9 ◽

2008 ◽

Vol 7 ◽

pp. 45-46

Author(s):

R PIATKOWSKI ◽

J KOCHANOWSKI ◽

P SCISLO ◽

M SPIEWAK ◽

M MARCHEL ◽

...

Keyword(s):

Myocardial Infarction ◽

Left Ventricle ◽

Mitral Regurgitation ◽

Ischemic Mitral Regurgitation ◽

St Elevation Myocardial Infarction ◽

Left Ventricle Function ◽

St Elevation ◽

Ventricle Function

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Abstract 16563: Outcomes of Acute Ischemic Mitral Regurgitation in Anterior versus Inferior ST Elevation Myocardial Infarction

Circulation ◽

10.1161/circ.132.suppl_3.16563 ◽

2015 ◽

Vol 132 (suppl_3) ◽

Author(s):

Amgad Mentias ◽

Mohammad Qasim Raza ◽

Amr F Barakat ◽

Amar Krishnaswamy ◽

Milind Y Desai ◽

...

Keyword(s):

Myocardial Infarction ◽

Blood Transfusion ◽

Mitral Regurgitation ◽

Length Of Hospital Stay ◽

Patient Characteristics ◽

Ischemic Mitral Regurgitation ◽

St Elevation Myocardial Infarction ◽

Kaplan Meier ◽

New Development ◽

St Elevation

Background: Acute ischemic mitral regurgitation (MR) is a detrimental complication of ST elevation myocardial infarction (STEMI). We studied a) patient characteristics in acute ischemic MR in anterior versus inferior STEMI and b) its impact on outcomes. Methods: We retrospectively studied all patients presenting with STEMI complicated by acute ischemic MR to our center from 1994-2014. Patients were divided into two groups: anterior and inferior STEMI. Endpoints were 30-day and 1-year mortality. All cases with new development of > 2+ MR on baseline echo within 3 days of index MI were analyzed. Results: Out of 4005 STEMI patients, there were 221 patients (52.5% males) with acute MR at an incidence of 5.5% [74/1666 (4.4%) in anterior vs 147/2306 (6.4%) in inferior STEMI, p=0.02]. At baseline, there were no significant differences between anterior vs. inferior STEMI in age, co-morbidities or degree of MR (Table). Mean ejection fraction (EF) was 31±14 vs 45±13% (p<0.01). Median length of hospital stay was 6 vs 4 days (p<0.01). Overall 30-day mortality was 20 with anterior vs 10% (p=0.03) with inferior while 1-year mortality was 43 vs 24% (p<0.01) respectively. Overall 30-day mortality in 2+, 3+ and 4+ MR was 9, 19 and 29% while 1-year mortality was 23, 39 and 41% (p<0.01). Factors associated with 1-year mortality were older age (Hazards Ratio or (HR) 1.5, 95% CI 1.3-1.9, p<0.01), EF (HR 0.96, 95% CI 0.94-0.97, p<0.01), higher degree of MR (HR 4.6, 95% CI 1.6-11.7, p<0.01), DM (HR 2.4, 95% CI 1.4-3.9, p<0.01), shock on presentation (HR 2.3, 9% CI 1.3-4, p<0.01) and blood transfusion (HR 2.4, 95% CI 1.5-4, p<0.01). Kaplan-Meier survival curves for both groups and across grades of MR are shown in figure 1a and b. Conclusion: Acute ischemic MR is seen more commonly with inferior yet has worse outcomes in anterior STEMI with increased short and long term mortality. Further, old age, low EF, higher degree of MR, shock on presentation, and need for blood transfusion are associated with worse outcomes.

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