title: Mitral regurgitation during a myocardial infarction--new predictors and prognostic significance at two years of follow-up.
abstract: OBJECTIVE
  Ischemic Mitral Regurgitation (MR) has early prognostic impact in Myocardial Infarction (MI). Its medium-term importance, especially of mild MR, has not been established.
  
  
  OBJECTIVE
  to determine new clinical/analytical predictors of MR in MI-patients and establish its prognostic value during two-year follow-up [endpoints: mortality, decompensated heart failure (dHF)].
  
  
  RESULTS
  796 patients admitted for MI (age 68.8±13.4, 63.2% males, 44.6% STEMI).
  
  
  METHODS
  Admission analytical study, risk scores, coronariography, pre-discharge echocardiogram. Patients followed for two years. Clinical/analytical predictors of pre-discharge MR assessed. Predictive model for presence of pre-discharge MR included GRACE for intra-hospital mortality [IHM](OR=1.008, p<0.001), glomerular filtration rate (GFR)[OR=0.993, p=0.048], admission haemoglobin (OR=0.84, p=0.003). In univariate analysis, moderate-severe MR predicted 2-year mortality (OR=3.32, p<0.001), but not dHF. Two year mortality rate was proportional to severity of pre-discharge MR. Mild MR (vs. no MR) associated with higher risk for 2-year mortality (OR=2.04, p=0.014) and re-admission for dHF (OR=2.55, p=0.001). Predictive model for 2-year mortality included MR severity (OR=1.42, p=0.033) and GRACE for IHM (OR=1.023, p<0.001).
  
  
  CONCLUSIONS
  GRACE score for IHM, GFR and admission haemoglobin independently predicted risk for pre-discharge MR. MR, including its milder form, was an independent predictor of 2-year mortality, adding prognostic power to GRACE score.
authors.affiliation: Cardiology Department, Coimbra Hospital Centre, Coimbra, Portugal. sergioncbarra@gmail.com
authors.forename: Sérgio
authors.initials: S
authors.lastname: Barra
authors.forename: Rui
authors.initials: R
authors.lastname: Providência
authors.forename: Luís
authors.initials: L
authors.lastname: Paiva
authors.forename: Pedro Lourenço
authors.initials: PL
authors.lastname: Gomes
authors.forename: Luís
authors.initials: L
authors.lastname: Seca
authors.forename: Joana
authors.initials: J
authors.lastname: Silva
authors.forename: José
authors.initials: J
authors.lastname: Nascimento
authors.forename: António
authors.initials: A
authors.lastname: Leitão-Marques
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005500:Follow-Up Studies; D005919:Glomerular Filtration Rate; D006333:Heart Failure / Q000209:etiology*; D017052:Hospital Mortality; D006801:Humans; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D008875:Middle Aged; D008944:Mitral Valve Insufficiency / Q000150:complications* / Q000401:mortality; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000150:complications* / Q000401:mortality; D011379:Prognosis; D012372:ROC Curve; D018570:Risk Assessment; D012720:Severity of Illness Index