Abstract 17660: Prevalence and Prognosis of Early Ischemic Moderate to Severe Mitral Regurgitation After Primary Percutaneous Coronary Intervention
Background: Previously reported prevalence of ischemic mitral regurgitation (IMR) ranged from 15-64%, with 3-16% developing late moderate to severe IMR. However, most of these studies were performed in a heterogeneous population and prior to the routine use of PCI for STEMI. The objective of this study was to determine the prevalence and clinical prognostic implication of early IMR after primary PCI.
Methods: Between January 2006 and July 2012, 174 consecutive patients referred to our tertiary care center for primary PCI, within 12 hours of symptoms onset, were included. Early post-MI (1-2 days) and late post-MI (244 days [85 - 533]) echocardiography data were analyzed. Patients were categorized according to their early post-MI IMR grading: no-MR group (≤ mild: n=155, 89%), MR group (≥ moderate: n=19, 11%).
Results: Mean age was 63 ± 12 years, 79% were males and median follow-up was 366 days [34-582]. At the end of follow-up, IMR ≥ moderate was documented in 15% of our entire cohort. MR regression (≥ moderate to ≤ mild) was seen in only 16% of patients in MR group. No important differences were observed in most clinical outcomes however only patients in the no-MR group had an increase in LVEF (47% ± 12 vs. 53% ± 13; p<0.0001). MACE was observed more often in the MR group (42% vs. 16%; p=0.01) and mainly driven by surgical revascularization (26% vs. 6%, p=0.01) and mitral valve intervention (26% vs. 0%, p<0.0001). MACE was independently predicted by: multivessel disease (MVD) (HR: 3.09 [95% CI, 1.47 - 7.13]; p=0.003), moderate or severe IMR (HR: 2.58 [95% CI, 1.08 - 5.53]; p=0.04), and LVESD ≥ 40 mm (HR: 2.13 [95% CI, 1.00 - 4.30]; p=0.05). Predictors of early post-MI moderate to severe MR were: current smoking history (OR: 4.75 [95% CI, 1.23 - 31.42]; p=0.02), and male sex (OR: 3.23 [95% CI, 1.11 - 7.70]; p=0.03).
Conclusions: Early moderate to severe IMR was documented in 11%. Three-quarter of patients with ≥ moderate IMR at baseline will have no regression of MR. Of those, around 25 % will subsequently require mitral valve surgery within the first year. Close clinical follow-up is highly recommended in patients with significant early IMR as indication for surgical intervention may arise.
- © 2013 by American Heart Association, Inc.