title: Outcomes of ischaemic mitral regurgitation in anterior versus inferior ST elevation myocardial infarction.
abstract: BACKGROUND
  Ischaemic mitral regurgitation (IMR) is a detrimental complication of ST elevation myocardial infarction (STEMI).
  
  
  OBJECTIVE
  We sought to determine patient characteristics and outcomes of patients with IMR with focus on anterior or inferior location of STEMI.
  
  
  METHODS
  All patients presenting with STEMI complicated by IMR to our centre who underwent primary percutaneous coronary intervention within the first 12 hours of presentation from 1995 to 2014 were included. IMR was graded from 1+ to 4+ within 3 days of index myocardial infarction by echocardiography, divided into 2 groups based on infarct location and outcomes were compared.
  
  
  RESULTS
  Overall, 805 patients were included. There were 302 (17.8%) patients with mitral regurgitation (MR) out of the 1700 patients with anterior STEMI while 503 (21.8%) had MR out of the 2305 patients with inferior STEMI. There was no significant difference between both groups in comorbidities, clinical presentation or door-to-balloon time (DBT; median 104 vs 106 min, p=0.5). 30-day and 1-year mortality were higher in anterior STEMI compared with inferior STEMI (14.9% vs 6.8% and 26.4% vs 14.3%, respectively, p<0.001 both), as well as 5-year mortality (39.7% vs 24.8%, p<0.01). When analysis was performed for each grade of IMR, anterior was associated with worse outcomes in every grade. On multivariate cox survival analysis, after adjustment for age, gender, comorbidities, grade of IMR, ejection fraction and DBT, anterior STEMI was still associated with worse outcomes (HR 1.62 (95% CI 1.23 to 2.12), p<0.001).
  
  
  CONCLUSIONS
  Although IMR occurs more frequently with inferior infarction, outcomes are worse following anterior infarction.
authors.affiliation: Heart and Vascular Institute, Cleveland Clinic , Cleveland, Ohio , USA.
authors.forename: Amgad
authors.initials: A
authors.lastname: Mentias
authors.affiliation: Heart and Vascular Institute, Cleveland Clinic , Cleveland, Ohio , USA.
authors.forename: Mohammad Q
authors.initials: MQ
authors.lastname: Raza
authors.affiliation: Heart and Vascular Institute, Cleveland Clinic , Cleveland, Ohio , USA.
authors.forename: Amr F
authors.initials: AF
authors.lastname: Barakat
authors.affiliation: Heart and Vascular Institute, Cleveland Clinic , Cleveland, Ohio , USA.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Hill
authors.affiliation: Heart and Vascular Institute, Cleveland Clinic , Cleveland, Ohio , USA.
authors.forename: Dalia
authors.initials: D
authors.lastname: Youssef
authors.affiliation: Heart and Vascular Institute, Cleveland Clinic , Cleveland, Ohio , USA.
authors.forename: Amar
authors.initials: A
authors.lastname: Krishnaswamy
authors.affiliation: Heart and Vascular Institute, Cleveland Clinic , Cleveland, Ohio , USA.
authors.forename: Milind Y
authors.initials: MY
authors.lastname: Desai
authors.affiliation: Heart and Vascular Institute, Cleveland Clinic , Cleveland, Ohio , USA.
authors.forename: Brian
authors.initials: B
authors.lastname: Griffin
authors.affiliation: Heart and Vascular Institute, Cleveland Clinic , Cleveland, Ohio , USA.
authors.forename: Stephen
authors.initials: S
authors.lastname: Ellis
authors.affiliation: Heart and Vascular Institute, Cleveland Clinic , Cleveland, Ohio , USA.
authors.forename: Venu
authors.initials: V
authors.lastname: Menon
authors.affiliation: Heart and Vascular Institute, Cleveland Clinic , Cleveland, Ohio , USA.
authors.forename: E Murat
authors.initials: EM
authors.lastname: Tuzcu
authors.affiliation: Heart and Vascular Institute, Cleveland Clinic , Cleveland, Ohio , USA.
authors.forename: Samir R
authors.initials: SR
authors.lastname: Kapadia