title: Impact of ischemic mitral regurgitation on long-term outcome of patients with ejection fraction above 0.30 undergoing first isolated myocardial revascularization.
abstract: BACKGROUND
  We evaluated the impact of ischemic mitral regurgitation (IMR) on long-term outcome of patients with an ejection fraction (EF) exceeding 0.30 undergoing isolated coronary artery bypass grafting (CABG).
  
  
  METHODS
  From November 1994 to December 2002, 4226 patients (EF > 0.30) underwent a first isolated CABG. Preoperative IMR was present in 1421 (33.6%, group IMR), of which 1254 had mild (1/4) and 167 had moderate (2/4). The remaining 2805 patients (66.4%, group no-IMR) showed no IMR. A nonparsimonious regression model was built to determine the propensity score. Ten-year freedom from death from any cause, cardiac death, and cardiac events was evaluated by the Kaplan-Meier method. Results of Cox analysis were adjusted by entering the propensity score as an independent variable.
  
  
  RESULTS
  All patients had similar early mortality (2.1% no-IMR vs 2.5% IMR, p = 0.502) and morbidity (6.5% no-IMR vs 6.6% IMR, p = 0.840). In patients with EF of 0.31 to 0.40, but not in those ones with EF exceeding 0.40, IMR grade was an independent variable for worse long-term freedom from cardiac death (82.8 +/- 3.2 vs 91.4 +/- 2.4; Cox hazard ratio [HR], 2.1 [95% confidence interval (CI), 1.1 to 4.1]; p = 0.0324) and cardiac events (78.6 +/- 3.5 vs 88.5 +/- 2.7; Cox HR, 2.0 [95% CI, 1.1 to 3.7]; p = 0.0174).
  
  
  CONCLUSIONS
  Mild or moderate IMR in patients with an EF exceeding 0.30 undergoing first isolated CABG influences long-term outcome when EF is 0.31 to 0.40, but not when it exceeds 0.40.
authors.affiliation: Department of Cardiac Surgery, University of Catania, Catania, Italy. calafiore@unich.it
authors.forename: Antonio M
authors.initials: AM
authors.lastname: Calafiore
authors.forename: Valerio
authors.initials: V
authors.lastname: Mazzei
authors.forename: Angela L
authors.initials: AL
authors.lastname: Iacò
authors.forename: Marco
authors.initials: M
authors.lastname: Contini
authors.forename: Antonio
authors.initials: A
authors.lastname: Bivona
authors.forename: Massimo
authors.initials: M
authors.lastname: Gagliardi
authors.forename: Paolo
authors.initials: P
authors.lastname: Bosco
authors.forename: Sabina
authors.initials: S
authors.lastname: Gallina
authors.forename: Michele
authors.initials: M
authors.lastname: Di Mauro
mesh_terms: D000368:Aged; D000787:Angina Pectoris / Q000601:surgery; D015897:Comorbidity; D001026:Coronary Artery Bypass; D005260:Female; D006333:Heart Failure / Q000453:epidemiology; D006801:Humans; D053208:Kaplan-Meier Estimate; D007676:Kidney Failure, Chronic / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D008944:Mitral Valve Insufficiency / Q000453:epidemiology* / Q000209:etiology; D017202:Myocardial Ischemia / Q000150:complications / Q000453:epidemiology / Q000401:mortality* / Q000601:surgery*; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D013318:Stroke Volume; D016896:Treatment Outcome