Okura Hiroyuki, Kataoka Toru, Yoshida Kiyoshi
First Department of Internal Medicine, Nara Medical University, Kashihara, Japan.
Division of Cardiology, Bell Land General Hospital, Sakai, Japan.
Heart. 2016 May;102(9):694-700. doi: 10.1136/heartjnl-2015-308536. Epub 2016 Feb 10.
Secondary mitral regurgitation (MR) is negatively related to the prognosis of patients with myocardial infarction (MI). Renin-angiotensin system inhibitors (RASI) may favourably affect left ventricular remodelling and reduce afterload and thereby improve prognosis of secondary MR. The aim of this study was to investigate if use of RASI improves prognosis of patients with MI with secondary MR.
A total of 953 patients with MI were enrolled in this study. Long-term prognosis was compared between patients with MI with no/mild MR (n=657), moderate MR (n=196) and severe MR (n=100). Patients with MI with significant (≥moderate) secondary MR were further divided into those treated with and without RASI. Survival and cardiac-event (all-cause death and congestive heart failure)-free survival were compared.
Long-term survival was significantly associated with severity of MR (log-rank, p<0.0001). In patients with significant MR (n=296), RASI was used in 130 patients (44%) and not used in 166 patients (56%). Ejection fraction (47.3±12.2 vs 46.6±13.4%, p=NS) and E/e' (18.4±8.1 vs 16.5±7.0, p=NS) were similar between the two groups. Kaplan-Meier curves for cardiac-event-free survival demonstrated that use of RASI was associated with better survival (p=0.006) as well as event-free survival (p=0.02). By univariable and multivariable Cox proportional hazard analysis, age (HR 1.046, 95% CI 1.002 to 1.091, p=0.039) and RASI (HR 0.480, 95% CI 0.231 to 0.995), p=0.048) were independent predictors of cardiac events.
Secondary MR affects prognosis in patients with MI. Use of RASI may be associated with better long-term prognosis in patients with MI with significant MR.
继发性二尖瓣反流（MR）与心肌梗死（MI）患者的预后呈负相关。肾素 - 血管紧张素系统抑制剂（RASI）可能对左心室重构产生有利影响，降低后负荷，从而改善继发性MR患者的预后。本研究的目的是调查使用RASI是否能改善合并继发性MR的MI患者的预后。
本研究共纳入953例MI患者。比较了无/轻度MR的MI患者（n = 657）、中度MR患者（n = 196）和重度MR患者（n = 100）的长期预后。合并显著（≥中度）继发性MR的MI患者进一步分为接受RASI治疗和未接受RASI治疗的两组。比较两组的生存率和无心脏事件（全因死亡和充血性心力衰竭）生存率。
长期生存率与MR严重程度显著相关（对数秩检验，p < 0.0001）。在显著MR患者（n = 296）中，130例患者（44%）使用了RASI，166例患者（56%）未使用。两组间射血分数（47.3±12.2 vs 46.6±13.4%）和E/e'（18.4±8.1 vs 16.5±7.0）相似（p = 无显著性差异）。无心脏事件生存率的Kaplan-Meier曲线显示，使用RASI与更好的生存率（p = 0.006）以及无事件生存率（p = 0.02）相关。通过单变量和多变量Cox比例风险分析，年龄（风险比1.046，95%置信区间1.002至1.091，p = 0.039）和RASI（风险比0.480，95%置信区间0.231至0.995，p = 0.048）是心脏事件的独立预测因素。
继发性MR影响MI患者的预后。对于合并显著MR的MI患者，使用RASI可能与更好的长期预后相关。
