Ischemic mitral regurgitation and non-ST-segment elevation acute myocardial infarction: long-term prognosis
Iván Javier Núñez Gil1, Leopoldo Pérez de Isla, Juan Carlos García-Rubira
1Servicio de Cardiología, Hospital Clínico San Carlos, Madrid, Spain. ibnsky@yahoo.es
Introduction And Objectives:
Ischemic mitral regurgitation (MR) is a common complication of acute myocardial infarction and has a negative impact on prognosis. However, few studies have been carried out on MR after non-ST-segment elevation acute myocardial infarction (NSTEMI). Our objective was to investigate the incidence, clinical predictors and long-term prognostic implications of MR in patients with NSTEMI.
Methods:
The prospective study included 237 consecutive patients who were discharged in functional class I or II after a first NSTEMI. Each underwent echocardiography during the first week of admission, and patients were followed up clinically for a median of 1011 days. The incidence of readmission for heart failure, unstable angina, reinfarction, death or all combined (i.e. the combined event or major adverse cardiac event [MACE]) was recorded.
Results:
The patients' mean age was 66+/-13 years and 74% were male. The incidence of MR was 40% (grade I in 71 patients, grade II in 15, grade III in 6, and grade IV in 3). Age, diabetes mellitus, multivessel disease and MR (HR=2.17; 95% confidence interval 1.30-3.64; P=.003) were all independently associated with a poor long-term prognosis, in terms of MACEs. Even the milder grades of MR were associated with more events.
Conclusions:
In our milieu, MR frequently occurs after NSTEMI. Its presence together with other unfavorable factors implies a poor long-term prognosis. This is also true for milder grades of MR. Consequently, MR should be fully assessed and followed-up after NSTEMI in all patients.
Insights
Ischemic mitral regurgitation (MR) frequently occurs after non-ST-segment elevation myocardial infarction (NSTEMI). Even mild MR, along with other factors, indicates a poor long-term prognosis, necessitating assessment and follow-up.
Area of Science:
- Cardiology
- Cardiovascular Medicine
- Echocardiography
Background:
- Ischemic mitral regurgitation (MR) is a known complication of acute myocardial infarction (MI) with negative prognostic implications.
- Limited research exists on MR specifically following non-ST-segment elevation myocardial infarction (NSTEMI).
Purpose of the Study:
- To determine the incidence of MR in patients post-NSTEMI.
- To identify clinical predictors associated with MR.
- To evaluate the long-term prognostic impact of MR after NSTEMI.
Main Methods:
- Prospective study of 237 patients discharged post-first NSTEMI (functional class I or II).
- Echocardiography performed within the first week of admission.
- Clinical follow-up for a median of 1011 days, recording major adverse cardiac events (MACE).
Main Results:
- MR incidence was 40% (various grades).
- Independent predictors of poor long-term prognosis (MACE) included age, diabetes mellitus, multivessel disease, and the presence of MR (HR=2.17).
- Even milder grades of MR were associated with increased adverse events.
Conclusions:
- MR is a frequent complication after NSTEMI.
- The presence of MR, particularly with other risk factors, signifies a poor long-term prognosis.
- Comprehensive assessment and follow-up of MR post-NSTEMI are recommended for all patients.
Related Concept Videos
01:23Mitral Regurgitation II: Clinical Features and Diagnostic Tests
01:20Mitral Regurgitation I: Introduction
01:25Mitral Regurgitation III: Medical Management
01:22Mitral Stenosis I: Introduction
01:19Acute Coronary Syndrome II: Pathophysiology and Clinical Manifestations
01:23Mitral Stenosis II: Clinical features and Diagnostic Tests