Outcome of patients sustaining acute ischemic mitral regurgitation during myocardial infarction

Ann Intern Med. 1992 Jul 1;117(1):18-24. doi: 10.7326/0003-4819-117-1-18.


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 1,480 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% CI, 12% to 36%), 42% at 6 months (CI, 28% to 56%), and 52% at 1 year (CI, 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.

Publication types

  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Acute Disease
  • Aged
  • Angioplasty, Balloon, Coronary
  • Cardiac Catheterization
  • Cohort Studies
  • Female
  • Hospital Mortality
  • Hospitals, University / statistics & numerical data
  • Humans
  • Male
  • Middle Aged
  • Mitral Valve Insufficiency / etiology*
  • Mitral Valve Insufficiency / mortality
  • Myocardial Infarction / complications*
  • Myocardial Infarction / mortality
  • Myocardial Infarction / therapy
  • North Carolina / epidemiology
  • Prognosis
  • Survival Analysis
  • Thrombolytic Therapy
  • Treatment Outcome