Outcome of patients sustaining acute ischemic mitral regurgitation during myocardial infarction.
OBJECTIVE
To describe outcomes of patients sustaining an acute myocardial infarction complicated by mitral regurgitation managed with contemporary reperfusion therapies.


METHODS
Inception cohort case study. Long-term follow-up was obtained in 99% of all patients.


METHODS
University referral center.


METHODS
A series of 1,480 consecutive patients presenting between April 1986 and March 1989 who had emergency cardiac catheterization within 6 hours of infarction. Fifty patients were found to have moderately severe or severe mitral regurgitation.


METHODS
Mortality; follow-up cardiac catheterization in patients with regurgitation.


RESULTS
Acute ischemic moderately severe to severe (3+ or 4+) mitral regurgitation was associated with a mortality of 24% at 30 days (95% CI, 12% to 36%), 42% at 6 months (CI, 28% to 56%), and 52% at 1 year (CI, 38% to 66%); multivariable analysis identified 3+ or 4+ mitral regurgitation as a possible independent predictor of mortality (P = 0.06). Patients with mitral regurgitation tended to be female, older, and to have cerebrovascular disease, diabetes, and preexisting symptomatic coronary artery disease. A physical examination did not identify 50% of patients with moderately severe to severe regurgitation. Acute reperfusion with thrombolysis or angioplasty did not reliably reverse valvular incompetence. In this observational study, the greatest in-hospital and 1-year mortalities were seen in patients reperfused with emergency balloon angioplasty, whereas patients managed medically or with coronary bypass surgery had lower mortalities.


CONCLUSIONS
Moderately severe to severe (3+ or 4+) mitral regurgitation complicating acute myocardial infarction portends a grave prognosis. Acute reperfusion does not reduce mortality to levels experienced by patients with lesser degrees of mitral regurgitation nor does it reliably restore valvular competence.
Tcheng
J E
JE
Duke University Medical Center, Durham, NC.
Jackman
J D
JD
Nelson
C L
CL
Gardner
L H
LH
Smith
L R
LR
Rankin
J S
JS
Califf
R M
RM
Stack
R S
RS
D000208:Acute Disease; D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D006328:Cardiac Catheterization; D015331:Cohort Studies; D005260:Female; D017052:Hospital Mortality; D006785:Hospitals, University / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D008944:Mitral Valve Insufficiency / Q000209:etiology* / Q000401:mortality; D009203:Myocardial Infarction / Q000150:complications* / Q000401:mortality / Q000628:therapy; D009657:North Carolina / Q000453:epidemiology; D011379:Prognosis; D016019:Survival Analysis; D015912:Thrombolytic Therapy; D016896:Treatment Outcome