Mitral regurgitation is an independent predictor of 1-year mortality in ST-elevation myocardial infarction patients presenting in cardiogenic shock on admission

Acute Card Care. 2010 Jun;12(2):51-7. doi: 10.3109/17482941003802148.


Background: Cardiogenic shock (CS) remains the most serious complication of acute ST-elevation myocardial infarction (STEMI). Mitral regurgitation (MR) is a frequent complication of STEMI and a well-known predictor of mortality in STEMI without CS. The purpose of this study was to determine the prognostic significance of MR in STEMI patients with CS on admission.

Methods: Mitral regurgitation was assessed in 147 consecutive STEMI patients with CS on admission and treated by primary percutaneous coronary intervention (PCI). Color Doppler of MR was graded with a 0 to 3 scale (none, n = 26; 1 = mild, n = 62; 2 = moderate, n = 40; 3 = severe, n = 19).

Results: Overall one-year mortality in the study cohort was 27%. One-year mortality was 8%, 23%, 30% and 58% for patients with no, mild, moderate and severe MR respectively (P <0.001). For each grade of MR increase, the odds for mortality increased with 71% (OR: 1.71; 95% CI: 1.02-2.87; P = 0.043) when adjusted for age, gender, previous myocardial infarction, left ventricular ejection fraction (LVEF) <40%, multivessel disease and no-reflow.

Conclusions: The presence of MR on early echocardiography is an important independent predictor of one-year mortality in STEMI patients with CS on admission treated by primary PCI.

MeSH terms

  • Aged
  • Angioplasty, Balloon, Coronary
  • Cohort Studies
  • Echocardiography, Doppler, Color
  • Electrocardiography
  • Emergency Service, Hospital
  • Female
  • Hospitalization
  • Humans
  • Male
  • Middle Aged
  • Mitral Valve Insufficiency / complications
  • Mitral Valve Insufficiency / diagnosis*
  • Mitral Valve Insufficiency / mortality*
  • Predictive Value of Tests
  • Risk Factors
  • Severity of Illness Index
  • Shock, Cardiogenic / mortality*
  • Shock, Cardiogenic / physiopathology*
  • Shock, Cardiogenic / therapy
  • Survival Rate