Mitral regurgitation is an independent predictor of 1-year mortality in ST-elevation myocardial infarction patients presenting in cardiogenic shock on admission.
BACKGROUND
Cardiogenic shock (CS) remains the most serious complication of acute ST-elevation myocardial infarction (STEMI). Mitral regurgitation (MR) is a frequent complication of STEMI and a well-known predictor of mortality in STEMI without CS. The purpose of this study was to determine the prognostic significance of MR in STEMI patients with CS on admission.


METHODS
Mitral regurgitation was assessed in 147 consecutive STEMI patients with CS on admission and treated by primary percutaneous coronary intervention (PCI). Color Doppler of MR was graded with a 0 to 3 scale (none, n = 26; 1 = mild, n = 62; 2 = moderate, n = 40; 3 = severe, n = 19).


RESULTS
Overall one-year mortality in the study cohort was 27%. One-year mortality was 8%, 23%, 30% and 58% for patients with no, mild, moderate and severe MR respectively (P <0.001). For each grade of MR increase, the odds for mortality increased with 71% (OR: 1.71; 95% CI: 1.02-2.87; P = 0.043) when adjusted for age, gender, previous myocardial infarction, left ventricular ejection fraction (LVEF) <40%, multivessel disease and no-reflow.


CONCLUSIONS
The presence of MR on early echocardiography is an important independent predictor of one-year mortality in STEMI patients with CS on admission treated by primary PCI.
Engström
Annemarie E
AE
Department of Cardiology, Academic Medical Center, Amsterdam, the Netherlands. j.p.henriques@amc.uva.nl <j.p.henriques@amc.uva.nl>
Vis
Marije M
MM
Bouma
Berto J
BJ
Claessen
Bimmer E P M
BE
Sjauw
Krischan D
KD
Baan
Jan
J
Meuwissen
Martijn
M
Koch
Karel T
KT
de Winter
Robbert J
RJ
Tijssen
Jan G P
JG
Piek
Jan J
JJ
Henriques
José P S
JP
D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D015331:Cohort Studies; D018618:Echocardiography, Doppler, Color; D004562:Electrocardiography; D004636:Emergency Service, Hospital; D005260:Female; D006760:Hospitalization; D006801:Humans; D008297:Male; D008875:Middle Aged; D008944:Mitral Valve Insufficiency / Q000150:complications / Q000175:diagnosis* / Q000401:mortality*; D011237:Predictive Value of Tests; D012307:Risk Factors; D012720:Severity of Illness Index; D012770:Shock, Cardiogenic / Q000401:mortality* / Q000503:physiopathology* / Q000628:therapy; D015996:Survival Rate