Mitral Regurgitation Following Acute Myocardial Infarction Treated by Percutaneous Coronary Intervention-Prevalence, Risk factors, and Predictors of Outcome
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Mitral Regurgitation Following Acute Myocardial Infarction Treated by Percutaneous Coronary Intervention-Prevalence, Risk factors, and Predictors of Outcome. / Sharma, Harish; Radhakrishnan, Ashwin; Nightingale, Peter; Brown, Samuel; May, John; O'Connor, Kieran; Shakeel, Iqra; Zia, Nawal; Doshi, Sagar N; Townend, Jonathan N; Myerson, Saul G; Kirchhof, Paulus; Ludman, Peter F; Adnan Nadir, M; Steeds, Richard P.
in: AM J CARDIOL, Jahrgang 157, 15.10.2021, S. 22-32.Publikationen: SCORING: Beitrag in Fachzeitschrift/Zeitung › SCORING: Zeitschriftenaufsatz › Forschung › Begutachtung
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TY - JOUR
T1 - Mitral Regurgitation Following Acute Myocardial Infarction Treated by Percutaneous Coronary Intervention-Prevalence, Risk factors, and Predictors of Outcome
AU - Sharma, Harish
AU - Radhakrishnan, Ashwin
AU - Nightingale, Peter
AU - Brown, Samuel
AU - May, John
AU - O'Connor, Kieran
AU - Shakeel, Iqra
AU - Zia, Nawal
AU - Doshi, Sagar N
AU - Townend, Jonathan N
AU - Myerson, Saul G
AU - Kirchhof, Paulus
AU - Ludman, Peter F
AU - Adnan Nadir, M
AU - Steeds, Richard P
N1 - Copyright © 2021 Elsevier Inc. All rights reserved.
PY - 2021/10/15
Y1 - 2021/10/15
N2 - Mitral regurgitation (MR) following acute myocardial infarction (AMI) worsens prognosis and reports of prevalence vary significantly. The objective was to determine prevalence, risk factors, and outcomes related to MR following AMI. We identified 1000 consecutive patients admitted with AMI in 2016/17 treated by percutaneous coronary intervention with pre-discharge transthoracic echocardiography. MR was observed in 294 of 1000 (29%), graded as mild (n = 224 [76%]), moderate (n = 61 [21%]) and severe (n = 9 [3%]). Compared with patients without MR, patients with MR were older (70 ± 12 vs 63 ± 13 years; p <0.001), with worse left ventricular ejection fraction (LVEF) (52 ± 15% vs 55 ± 11%; p <0.001) and creatinine clearance (69 ± 33 ml/min vs 90 ± 39 ml/min; p <0.001). They also had higher rates of hypertension (64% vs 55%; p = 0.012), heart failure (3.4% vs 1.1%; p = 0.014), previous MI (28% vs 20%; p = 0.005) and severe flow-limitation in the circumflex (50% vs 33%; p <0.001) or right coronary artery (51% vs 42%; p = 0.014). Prevalence and severity of MR were unaffected by AMI subtype. Revascularization later than 72 hours from symptom-onset was associated with increased likelihood of MR (33% vs 25%; p = 0.036) in patients with non-ST elevation myocardial infarction (NSTEMI). After a mean of 3.2 years, 56 of 288 (19%) patients with untreated MR died. Age and LVEF independently predicted mortality. The presence of even mild MR was associated with increased mortality (p = 0.029), despite accounting for confounders. In conclusion, MR is observed in over one-quarter of patients after AMI and associated with lower survival, even when mild. Prevalence and severity are independent of MI subtype, but MR was more common with delayed revascularization following NSTEMI.
AB - Mitral regurgitation (MR) following acute myocardial infarction (AMI) worsens prognosis and reports of prevalence vary significantly. The objective was to determine prevalence, risk factors, and outcomes related to MR following AMI. We identified 1000 consecutive patients admitted with AMI in 2016/17 treated by percutaneous coronary intervention with pre-discharge transthoracic echocardiography. MR was observed in 294 of 1000 (29%), graded as mild (n = 224 [76%]), moderate (n = 61 [21%]) and severe (n = 9 [3%]). Compared with patients without MR, patients with MR were older (70 ± 12 vs 63 ± 13 years; p <0.001), with worse left ventricular ejection fraction (LVEF) (52 ± 15% vs 55 ± 11%; p <0.001) and creatinine clearance (69 ± 33 ml/min vs 90 ± 39 ml/min; p <0.001). They also had higher rates of hypertension (64% vs 55%; p = 0.012), heart failure (3.4% vs 1.1%; p = 0.014), previous MI (28% vs 20%; p = 0.005) and severe flow-limitation in the circumflex (50% vs 33%; p <0.001) or right coronary artery (51% vs 42%; p = 0.014). Prevalence and severity of MR were unaffected by AMI subtype. Revascularization later than 72 hours from symptom-onset was associated with increased likelihood of MR (33% vs 25%; p = 0.036) in patients with non-ST elevation myocardial infarction (NSTEMI). After a mean of 3.2 years, 56 of 288 (19%) patients with untreated MR died. Age and LVEF independently predicted mortality. The presence of even mild MR was associated with increased mortality (p = 0.029), despite accounting for confounders. In conclusion, MR is observed in over one-quarter of patients after AMI and associated with lower survival, even when mild. Prevalence and severity are independent of MI subtype, but MR was more common with delayed revascularization following NSTEMI.
KW - Aged
KW - Echocardiography
KW - Female
KW - Humans
KW - Male
KW - Middle Aged
KW - Mitral Valve Insufficiency/epidemiology
KW - Myocardial Infarction/complications
KW - Percutaneous Coronary Intervention
KW - Prevalence
KW - Prognosis
KW - Prospective Studies
KW - Retrospective Studies
KW - Risk Assessment/methods
KW - Risk Factors
KW - Stroke Volume/physiology
KW - United Kingdom/epidemiology
KW - Ventricular Function, Left/physiology
U2 - 10.1016/j.amjcard.2021.07.029
DO - 10.1016/j.amjcard.2021.07.029
M3 - SCORING: Journal article
C2 - 34417016
VL - 157
SP - 22
EP - 32
JO - AM J CARDIOL
JF - AM J CARDIOL
SN - 0002-9149
ER -
