title: Outcome of patients sustaining acute ischemic mitral regurgitation during myocardial infarction.
abstract: 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.
authors.affiliation: Duke University Medical Center, Durham, NC.
authors.forename: J E
authors.initials: JE
authors.lastname: Tcheng
authors.forename: J D
authors.initials: JD
authors.lastname: Jackman
authors.forename: C L
authors.initials: CL
authors.lastname: Nelson
authors.forename: L H
authors.initials: LH
authors.lastname: Gardner
authors.forename: L R
authors.initials: LR
authors.lastname: Smith
authors.forename: J S
authors.initials: JS
authors.lastname: Rankin
authors.forename: R M
authors.initials: RM
authors.lastname: Califf
authors.forename: R S
authors.initials: RS
authors.lastname: Stack
mesh_terms: 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