title: Time course, predictors, and prognostic implications of significant mitral regurgitation after ST-segment elevation myocardial infarction.
abstract: Ischemic mitral regurgitation (MR) is a known complication of ST-segment elevation myocardial infarction (STEMI) with important prognostic implications. We evaluated changes over time in ischemic MR after STEMI and the prevalence and predictors of significant (grade ≥2) MR at 12 months. Furthermore, the prognostic additional value of significant MR at 12-month follow-up over acute MR was assessed.
  
  
  
  STEMI patients (n = 1,599; 77% male; 60 ± 12 years) treated with primary percutaneous coronary intervention underwent echocardiography <48 hours of admission (baseline) and at 12 months. Mortality data were collected during long-term follow-up.
  
  
  
  At baseline, significant MR was present in 103 (6%) patients. After 12 months, MR worsened ≥1 grade in 321 (20%) patients, remained stable in 963 (60%), and improved ≥1 grade in 315 (20%). Significant MR was present in 135 patients at 12 months (8%, P = .01 vs baseline). Age, left ventricular end-systolic volume, and significant MR at baseline were independently associated with significant MR at follow-up. During follow-up (median, 50 months), 121 (8%) patients died (40% of cardiovascular cause). Significant MR at follow-up was independently associated with all-cause (hazard ratio, 1.65, 95% CI, 1.02-2.99) and cardiovascular mortality (hazard ratio, 2.47; 95% CI, 1.24-4.92), also after adjusting for significant MR at baseline.
  
  
  
  The prevalence of significant MR after STEMI increases over time. Age, baseline left ventricular end-systolic volume, and baseline significant MR are independently associated with significant MR at follow-up. Significant MR at 12 months is associated with subsequent all-cause and cardiovascular mortality and shows additional prognostic value over acute MR.
authors: Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands.
authors: Elena
authors: E
authors: Abate
authors: Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands.
authors: Georgette E
authors: GE
authors: Hoogslag
authors: Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands.
authors: Ibtihal
authors: I
authors: Al Amri
authors: Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands; Department of Cardiology, Sint-Jan Hospital Bruges, Bruges, Belgium.
authors: Philippe
authors: P
authors: Debonnaire
authors: Department of Medical Statistics and Bioinformatics, Leiden University Medical Center, Leiden, the Netherlands.
authors: Ron
authors: R
authors: Wolterbeek
authors: Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands.
authors: Jeroen J
authors: JJ
authors: Bax
authors: Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands.
authors: Victoria
authors: V
authors: Delgado
authors: Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands. Electronic address: N.Ajmone@lumc.nl.
authors: Nina Ajmone
authors: NA
authors: Marsan
mesh_terms: D000368:Aged; D002318:Cardiovascular Diseases / Q000401:mortality; D002423:Cause of Death; D018450:Disease Progression; D004452:Echocardiography; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D008944:Mitral Valve Insufficiency / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000503:physiopathology; D009026:Mortality; D011379:Prognosis; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D000072657:ST Elevation Myocardial Infarction / Q000453:epidemiology* / Q000503:physiopathology; D012720:Severity of Illness Index; D013318:Stroke Volume; D013997:Time Factors