TY - JOUR
T1 - Outcome of patients sustaining acute ischemic mitral regurgitation during myocardial infarction
AU - Tcheng, James E.
AU - Jackman, John D.
AU - Nelson, Charlotte L.
AU - Gardner, Laura H.
AU - Smith, L. Richard
AU - Rankin, J. Scott
AU - Califf, Robert M.
AU - Stack, Richard S.
N1 - Copyright:
Copyright 2018 Elsevier B.V., All rights reserved.
PY - 1992/7/1
Y1 - 1992/7/1
N2 - Objective: To describe outcomes of patients sustaining an acute myocardial infarction complicated by mitral regurgitation managed with contemporary reperfusion therapies. Design: Inception cohort case study. Long-term follow-up was obtained in 99% of all patients. Setting: University referral center. Patients: A series of 1480 consecutive patients presenting between April 1986 and March 1989 who had emergency cardiac catheterization within 6 hours of infarction. Fifty patients were found to have moderately severe or severe mitral regurgitation. Outcome Measures: Mortality; follow-up cardiac catheterization in patients with regurgitation. Results: Acute ischemic moderately severe to severe (3 + or 4 +) mitral regurgitation was associated with a mortality of 24% at 30 days (95% Cl, 12% to 36%), 42% at 6 months (Cl, 28% to 56%), and 52% at 1 year (Cl, 38% to 66%); multivariable analysis identified 3 + or 4 + mitral regurgitation as a possible independent predictor of mortality (P = 0.06). Patients with mitral regurgitation tended to be female, older, and to have cerebrovascular disease, diabetes, and preexisting symptomatic coronary artery disease. A physical examination did not identify 50% of patients with moderately severe to severe regurgitation. Acute reperfusion with thrombolysis or angioplasty did not reliably reverse valvular incompetence. In this observational study, the greatest in-hospital and 1-year mortalities were seen in patients reperfused with emergency balloon angioplasty, whereas patients managed medically or with coronary bypass surgery had lower mortalities. Conclusions: Moderately severe to severe (3 + or 4 +) mitral regurgitation complicating acute myocardial infarction portends a grave prognosis. Acute reperfusion does not reduce mortality to levels experienced by patients with lesser degrees of mitral regurgitation nor does it reliably restore valvular competence.
AB - Objective: To describe outcomes of patients sustaining an acute myocardial infarction complicated by mitral regurgitation managed with contemporary reperfusion therapies. Design: Inception cohort case study. Long-term follow-up was obtained in 99% of all patients. Setting: University referral center. Patients: A series of 1480 consecutive patients presenting between April 1986 and March 1989 who had emergency cardiac catheterization within 6 hours of infarction. Fifty patients were found to have moderately severe or severe mitral regurgitation. Outcome Measures: Mortality; follow-up cardiac catheterization in patients with regurgitation. Results: Acute ischemic moderately severe to severe (3 + or 4 +) mitral regurgitation was associated with a mortality of 24% at 30 days (95% Cl, 12% to 36%), 42% at 6 months (Cl, 28% to 56%), and 52% at 1 year (Cl, 38% to 66%); multivariable analysis identified 3 + or 4 + mitral regurgitation as a possible independent predictor of mortality (P = 0.06). Patients with mitral regurgitation tended to be female, older, and to have cerebrovascular disease, diabetes, and preexisting symptomatic coronary artery disease. A physical examination did not identify 50% of patients with moderately severe to severe regurgitation. Acute reperfusion with thrombolysis or angioplasty did not reliably reverse valvular incompetence. In this observational study, the greatest in-hospital and 1-year mortalities were seen in patients reperfused with emergency balloon angioplasty, whereas patients managed medically or with coronary bypass surgery had lower mortalities. Conclusions: Moderately severe to severe (3 + or 4 +) mitral regurgitation complicating acute myocardial infarction portends a grave prognosis. Acute reperfusion does not reduce mortality to levels experienced by patients with lesser degrees of mitral regurgitation nor does it reliably restore valvular competence.
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U2 - 10.7326/0003-4819-117-1-18
DO - 10.7326/0003-4819-117-1-18
M3 - Article
C2 - 1596043
AN - SCOPUS:0026696691
VL - 117
SP - 18
EP - 24
JO - Annals of Internal Medicine
JF - Annals of Internal Medicine
SN - 0003-4819
IS - 1
ER -