Long-term outcomes of patients with mitral regurgitation undergoing percutaneous coronary intervention.
The most appropriate treatment for patients with ischemic mitral regurgitation (MR) remains controversial. MR has prognostic importance in patients after myocardial infarction and those undergoing coronary artery bypass surgery, but the long-term outcomes after percutaneous coronary intervention (PCI) are less well defined. We evaluated patients who underwent PCI and had assessment of MR by left ventriculography and/or echocardiography in the year 2000. We determined effects of MR on 30-day and 5-year survival. The cohort included 711 patients (67% men) with an average age of 64.5 +/- 12.4 years. MR severity was divided into 3 strata: none (n = 420, 59%), mild (n = 209, 29%), and moderate to severe (n = 82, 12%). Patients with more severe MR differed from patients with mild or no MR in that they were older (p <0.001), more frequently women (p <0.001), and more likely to have a coronary artery bypass graft (p <0.001), myocardial infarction (p <0.001), and lower ejection fraction (p <0.001). Decreased survival rates were associated with increasing MR severity (none vs mild vs moderate to severe) at 30 days (100%, 98.7%, and 96.6%, respectively; p <0.0025) and 5 years (97%, 83.3%, and 57.5%; p <0.0001). MR was an important independent predictor of survival (hazard ratio 1.57, p <0.0009). In conclusion, patients with ischemic MR undergoing PCI have significantly decreased survival rates at 5 years, and severity of MR is an independent predictor of survival.
Pastorius
Catherine A
CA
Minneapolis Heart Institute Foundation at Abbott Northwestern Hospital, Minneapolis, MN, USA.
Henry
Timothy D
TD
Harris
Kevin M
KM
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015906:Angioplasty, Balloon, Coronary; D016208:Databases, Factual; D004452:Echocardiography; D005260:Female; D006801:Humans; D008297:Male; D008499:Medical Records; D008875:Middle Aged; D008910:Minnesota / Q000453:epidemiology; D008944:Mitral Valve Insufficiency / Q000150:complications* / Q000000981:diagnostic imaging / Q000473:pathology; D009203:Myocardial Infarction / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000209:etiology / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D012189:Retrospective Studies; D012720:Severity of Illness Index; D016019:Survival Analysis; D016896:Treatment Outcome