title: Prognostic importance of mitral regurgitation complicated by acute myocardial infarction during a 5-year follow-up period in the drug-eluting stent era.
abstract: BACKGROUND
  Mitral regurgitation (MR) is a frequent complication of left-ventricular dysfunction, with an incidence ranging from 13 to 59% after acute myocardial infarction (AMI), which is associated with poor clinical outcome. The aim of this study was to assess the clinical and angiographic characteristics associated with MR, the incidence and predictors of MR, and the outcomes of MR after AMI in those who were successfully treated with primary percutaneous coronary intervention (PCI) using a drug-eluting stent.
  
  
  METHODS
  We analyzed a multicenter all-comer AMI registry and identified 4748 patients between January 2004 and December 2009. Of these, 1894 patients were treated with PCI using a drug-eluting stent and had MR. The association between MR and the composite of major adverse cardiac and cerebrovascular events (MACCE; all-cause death, recurrent nonfatal myocardial infarction, stroke, and any revascularization) was examined.
  
  
  RESULTS
  Patients with MR after the index PCI showed significantly higher cumulative incidence of MACCE compared with no-MR patients over the 5-year survival period (P=0.002). When the MR groups were compared on the basis of the severity of MR, ranging from mild to severe grades, a higher grade of MR was found to be associated with a higher incidence of MACCE (P<0.001). Multivariate Cox proportional hazard analysis revealed that no reflow, left-ventricular ejection fraction less than 50%, and anemia, in addition to MR, were consistently associated with increased all-cause death during the 5-year period (adjusted hazard ratio 1.408, 95% confidence interval 1.052-1.884, P=0.021).
  
  
  CONCLUSIONS
  MR after AMI in patients successfully treated with primary PCI was associated with poor long-term outcome regardless of ST-segment elevation at diagnosis during the drug-eluting stent era.
authors.affiliation: aDepartment of Internal Medicine, Division of Cardiology, Seoul St Mary's Hospital bDepartment of Internal Medicine, Division of Cardiology, St Paul's Hospital cDepartment of Internal Medicine, Division of Cardiology, Yeouido St Mary's Hospital, The Catholic University of Korea, Seoul dDepartment of Internal Medicine, Division of Cardiology, Daejeon St Mary's Hospital, The Catholic University of Korea, Daejeon eDepartment of Internal Medicine, Division of Cardiology, Uijeongbu St Mary's Hospital, The Catholic University of Korea, Uijengbu fDepartment of Internal Medicine, Division of Cardiology, Bucheon St Mary's Hospital, The Catholic University of Korea, Bucheon gDepartment of Internal Medicine, Division of Cardiology, St Vincent's Hospital, The Catholic University of Korea, Suwon hDepartment of Internal Medicine, Division of Cardiology, Incheon St Mary's Hospital, The Catholic University of Korea, Incheon iDepartment of Internal Medicine, Division of Cardiology, Chonnam National University Hospital, Chonnam National University, Gwangju, Korea.
authors.forename: Tae-Hoon
authors.initials: TH
authors.lastname: Kim
authors.forename: Kwan Yong
authors.initials: KY
authors.lastname: Lee
authors.forename: Young
authors.initials: Y
authors.lastname: Choi
authors.forename: Ha-Wook
authors.initials: HW
authors.lastname: Park
authors.forename: Young Soo
authors.initials: YS
authors.lastname: Lee
authors.forename: Yoon Seok
authors.initials: YS
authors.lastname: Koh
authors.forename: Hun-Jun
authors.initials: HJ
authors.lastname: Park
authors.forename: Pum-Joon
authors.initials: PJ
authors.lastname: Kim
authors.forename: Kiyuk
authors.initials: K
authors.lastname: Chang
authors.forename: Wook Sung
authors.initials: WS
authors.lastname: Chung
authors.forename: Dong-Bin
authors.initials: DB
authors.lastname: Kim
authors.forename: Sung-Ho
authors.initials: SH
authors.lastname: Her
authors.forename: Chul Soo
authors.initials: CS
authors.lastname: Park
authors.forename: Jong Min
authors.initials: JM
authors.lastname: Lee
authors.forename: Hee-Yeol
authors.initials: HY
authors.lastname: Kim
authors.forename: Ki Dong
authors.initials: KD
authors.lastname: Yoo
authors.forename: Doo Soo
authors.initials: DS
authors.lastname: Jeon
authors.forename: Youngkeun
authors.initials: Y
authors.lastname: Ahn
authors.forename: Myung-Ho
authors.initials: MH
authors.lastname: Jeong
authors.forename: Ki-Bae
authors.initials: KB
authors.lastname: Seung
mesh_terms: D000367:Age Factors; D000368:Aged; D001281:Atrial Fibrillation / Q000453:epidemiology; D054855:Drug-Eluting Stents; D005260:Female; D006801:Humans; D006937:Hypercholesterolemia / Q000453:epidemiology; D015994:Incidence; D008297:Male; D008875:Middle Aged; D008944:Mitral Valve Insufficiency / Q000209:etiology*; D009026:Mortality; D009203:Myocardial Infarction / Q000150:complications / Q000453:epidemiology / Q000601:surgery*; D009204:Myocardial Revascularization / Q000706:statistics & numerical data; D054318:No-Reflow Phenomenon / Q000453:epidemiology; D062645:Percutaneous Coronary Intervention; D011379:Prognosis; D016016:Proportional Hazards Models; D012008:Recurrence; D012042:Registries; D012189:Retrospective Studies; D012307:Risk Factors; D020521:Stroke / Q000453:epidemiology; D013318:Stroke Volume; D018487:Ventricular Dysfunction, Left / Q000209:etiology / Q000503:physiopathology