Long-term prognostic value of mitral regurgitation in patients with ST-segment elevation myocardial infarction treated by primary percutaneous coronary intervention.
The presence of mitral regurgitation (MR) is associated with an impaired prognosis in patients with ischemic heart disease. However, data with regard to the impact of this condition in patients with ST-segment elevation myocardial infarction (STEMI) treated by means of primary percutaneous coronary intervention (PPCI) are lacking. Our aim was to assess the effect of MR in the long-term prognosis of patients with STEMI after PPCI. We analyzed a prospective registry of 1,868 patients (mean age 62 ± 13 years, 79.9% men) with STEMI treated by PPCI in our center from January 2006 to December 2010. Our primary outcome was the composite end point of all-cause mortality or admission due to heart failure during follow-up. After exclusions, 1,036 patients remained for the final analysis. Moderate or severe MR was detected in 119 patients (11.5%). Those with more severe MR were more frequently women (p <0.001), older (p <0.001), and with lower ejection fraction (p <0.001). After a median follow-up of 2.8 years (1.7 to 4.3), a total of 139 patients (13.4%) experienced our primary end point. There was an association between the unfavorable combined event and the degree of MR (p <0.001). After adjustment for relevant confounders, moderate or severe MR remained as an independent predictor of the combined primary end point (adjusted hazard ratio [HR] 3.14, 95% confidence interval [CI] 1.57 to 6.27) and each event separately (adjusted HR death 3.1, 95% CI 1.34 to 7.2; adjusted HR heart failure 3.3, 95% CI 1.16 to 9.4). In conclusion, moderate or severe MR detected early with echocardiography was independently associated with a worse long-term prognosis in patients with STEMI treated with PPCI.
Cardiology Department, Complejo Hospitalario Universitario A Coruña, A Coruña, Spain.
Manuel
M
López-Pérez
Cardiology Department, Complejo Hospitalario Universitario A Coruña, A Coruña, Spain; Interventional Cardiology Unit, Division of Cardiology, Complejo Asistencial Universitario de León, Fundación Investigación Sanitaria de León (FISLeon), León, Spain. Electronic address: roiestevez@hotmail.com.
Rodrigo
R
Estévez-Loureiro
Cardiology Department, Complejo Hospitalario Universitario A Coruña, A Coruña, Spain.
Angela
A
López-Sainz
Cardiology Department, Complejo Hospitalario Universitario A Coruña, A Coruña, Spain.
David
D
Couto-Mallón
Cardiology Department, Complejo Hospitalario Universitario A Coruña, A Coruña, Spain.
María Rita
MR
Soler-Martin
Cardiology Department, Complejo Hospitalario Universitario A Coruña, A Coruña, Spain.
Alberto
A
Bouzas-Mosquera
Cardiology Department, Complejo Hospitalario Universitario A Coruña, A Coruña, Spain.
Jesús
J
Peteiro
Cardiology Department, Complejo Hospitalario Universitario A Coruña, A Coruña, Spain.
Gonzalo
G
Barge-Caballero
Cardiology Department, Complejo Hospitalario Universitario A Coruña, A Coruña, Spain.
Oscar
O
Prada-Delgado
Cardiology Department, Complejo Hospitalario Universitario A Coruña, A Coruña, Spain.
Eduardo
E
Barge-Caballero
Cardiology Department, Complejo Hospitalario Universitario A Coruña, A Coruña, Spain.
Jorge
J
Salgado-Fernández
Cardiology Department, Complejo Hospitalario Universitario A Coruña, A Coruña, Spain.
Ramón
R
Calviño-Santos
Cardiology Department, Complejo Hospitalario Universitario A Coruña, A Coruña, Spain.
José Manuel
JM
Vázquez-Rodríguez
Cardiology Department, Complejo Hospitalario Universitario A Coruña, A Coruña, Spain.
Pablo
P
Piñón-Esteban
Cardiology Department, Complejo Hospitalario Universitario A Coruña, A Coruña, Spain.
Guillermo
G
Aldama-López
Cardiology Department, Complejo Hospitalario Universitario A Coruña, A Coruña, Spain.
Nicolás
N
Vázquez-González
Cardiology Department, Complejo Hospitalario Universitario A Coruña, A Coruña, Spain.
Alfonso
A
Castro-Beiras
D000368:Aged; D002423:Cause of Death / Q000639:trends; D017023:Coronary Angiography; D018618:Echocardiography, Doppler, Color; D004562:Electrocardiography; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D008944:Mitral Valve Insufficiency / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology*; D009203:Myocardial Infarction / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D062645:Percutaneous Coronary Intervention / Q000379:methods*; D011379:Prognosis; D011446:Prospective Studies; D013030:Spain / Q000453:epidemiology; D015996:Survival Rate / Q000639:trends; D013997:Time Factors