Mitral regurgitation during a myocardial infarction--new predictors and prognostic significance at two years of follow-up

Acute Card Care. 2012 Mar;14(1):27-33. doi: 10.3109/17482941.2012.655295. Epub 2012 Feb 1.


Aims: Ischemic Mitral Regurgitation (MR) has early prognostic impact in Myocardial Infarction (MI). Its medium-term importance, especially of mild MR, has not been established.

Purpose: to determine new clinical/analytical predictors of MR in MI-patients and establish its prognostic value during two-year follow-up [endpoints: mortality, decompensated heart failure (dHF)].

Methods and results: 796 patients admitted for MI (age 68.8±13.4, 63.2% males, 44.6% STEMI).

Data: Admission analytical study, risk scores, coronariography, pre-discharge echocardiogram. Patients followed for two years. Clinical/analytical predictors of pre-discharge MR assessed. Predictive model for presence of pre-discharge MR included GRACE for intra-hospital mortality [IHM](OR=1.008, p<0.001), glomerular filtration rate (GFR)[OR=0.993, p=0.048], admission haemoglobin (OR=0.84, p=0.003). In univariate analysis, moderate-severe MR predicted 2-year mortality (OR=3.32, p<0.001), but not dHF. Two year mortality rate was proportional to severity of pre-discharge MR. Mild MR (vs. no MR) associated with higher risk for 2-year mortality (OR=2.04, p=0.014) and re-admission for dHF (OR=2.55, p=0.001). Predictive model for 2-year mortality included MR severity (OR=1.42, p=0.033) and GRACE for IHM (OR=1.023, p<0.001).

Conclusion: GRACE score for IHM, GFR and admission haemoglobin independently predicted risk for pre-discharge MR. MR, including its milder form, was an independent predictor of 2-year mortality, adding prognostic power to GRACE score.

MeSH terms

  • Aged
  • Aged, 80 and over
  • Female
  • Follow-Up Studies
  • Glomerular Filtration Rate
  • Heart Failure / etiology*
  • Hospital Mortality
  • Humans
  • Kaplan-Meier Estimate
  • Logistic Models
  • Middle Aged
  • Mitral Valve Insufficiency / complications*
  • Mitral Valve Insufficiency / mortality
  • Multivariate Analysis
  • Myocardial Infarction / complications*
  • Myocardial Infarction / mortality
  • Prognosis
  • ROC Curve
  • Risk Assessment*
  • Severity of Illness Index