Predictors and prognosis of early ischemic mitral regurgitation in the era of primary percutaneous coronary revascularisation.
BACKGROUND
Studies assessing ischemic mitral regurgitation (IMR) comprised of heterogeneous population and evaluated IMR in the subacute setting. The incidence of early IMR in the setting of primary PCI, its progression and clinical impact over time is still undetermined. We sought to determine the predictors and prognosis of early IMR after primary percutaneous coronary intervention (PCI) for ST-elevation myocardial infarction (STEMI).


METHODS
Using our primary PCI database, we screened for patients who underwent ≥2 transthoracic echocardiograms early (1-3 days) and late (1 year) following primary PCI. The primary outcomes were: (1) major adverse events (MACE) including death, ischemic events, repeat hospitalization, re-vascularization and mitral repair or replacement (2) changes in quantitative echocardiographic assessments.


RESULTS
From January 2006 to July 2012, we included 174 patients. Post-primary PCI IMR was absent in 95 patients (55%), mild in 60 (34%), and moderate to severe in 19 (11%). Early after primary PCI, IMR was independently predicted by an ischemic time > 540 min (OR: 2.92 [95% CI, 1.28 - 7.05]; p = 0.01), and female gender (OR: 3.06 [95% CI, 1.42 - 6.89]; p = 0.004). At a median follow-up of 366 days [34-582 days], IMR was documented in 44% of the entire cohort, with moderate to severe IMR accounting for 15%. During follow-up, MR regression (change ≥ 1 grade) was seen in 18% of patients. Moderate to severe IMR remained an independent predictor of MACE (HR: 2.58 [95% CI, 1.08 - 5.53]; p = 0.04).


CONCLUSIONS
After primary PCI, IMR is a frequent finding. Regression of early IMR during long-term follow-up is uncommon. Since moderate to severe IMR post-primary PCI appears to be correlated with worse outcomes, close follow-up is required.
Jimmy
J
MacHaalany
Olivier F
OF
Bertrand
Kim
K
O'Connor
Eltigani
E
Abdelaal
Pierre
P
Voisine
Éric
É
Larose
Éric
É
Charbonneau
Olivier
O
Costerousse
Jean-Pierre
JP
Déry
Department of Cardiology, Institut Universitaire de Cardiologie et de Pneumologie de Québec, 2725 chemin Sainte-Foy, G1V 4G5 Quebec City, Quebec, Canada. mario.senechal@criucpq.ulaval.ca.
Mario
M
Sénéchal
D000368:Aged; D001026:Coronary Artery Bypass; D003324:Coronary Artery Disease / Q000401:mortality / Q000601:surgery / Q000628:therapy*; D016208:Databases, Factual; D042241:Early Diagnosis; D004452:Echocardiography / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery; D019918:Heart Valve Prosthesis Implantation; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D008944:Mitral Valve Insufficiency / Q000000981:diagnostic imaging* / Q000401:mortality* / Q000601:surgery; D009203:Myocardial Infarction / Q000401:mortality / Q000601:surgery / Q000628:therapy*; D062645:Percutaneous Coronary Intervention; D011237:Predictive Value of Tests; D011379:Prognosis; D016896:Treatment Outcome