Mentias Amgad, Raza Mohammad Q, Barakat Amr F, Hill Elizabeth, Youssef Dalia, Krishnaswamy Amar, Desai Milind Y, Griffin Brian, Ellis Stephen, Menon Venu, Tuzcu E Murat, Kapadia Samir R
Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio.
Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio.
Am J Cardiol. 2017 Jan 1;119(1):20-26. doi: 10.1016/j.amjcard.2016.09.007. Epub 2016 Sep 29.
Ischemic mitral regurgitation (IMR) has been associated with worse outcome myocardial infarction. However, severity of mitral regurgitation (MR) and its impact on patients with ST-elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI) remains unknown. We sought to determine impact of increasing severity of IMR on outcomes in patients with STEMI undergoing primary PCI. All patients presenting with STEMI who underwent primary PCI within 12 hours of symptoms from 1994 to 2014 were included. IMR was graded from 0 to 4+ within 3 days of index myocardial infarction by echocardiography. Overall, 4,005 patients with STEMI were included. None, 1+, 2+, 3+, and 4+ MR were present in 3,200 (79.9%), 427 (10.7%), 260 (6.5%), 91 (2.3%), and 27 (0.7%) patients, respectively. On multivariate logistic regression analysis, more severe MR was associated with older age, female gender, lower body mass index, anemia, inferior STEMI, and longer door-to-balloon time. The 30-day mortality rates were 6.8%, 7.3%, 8.8%, 19.8%, and 26.1%, respectively, with increasing grade of MR. The 1-year mortality rates were 10.8%, 12.4%, 20.8%, 37.4%, and 37.1%, whereas 5-year mortality rates were 16.2%, 23.1%, 36.5%, 53.8%, and 63%, respectively (p <0.001 all), for none to 4+ MR. After adjusting for age, gender, co-morbidities, ejection fraction, and shock by multivariate analysis, severity of IMR was associated with incremental effect on long-term mortality (hazard ratios of 1.42, 1.83, 2.41, and 2.95 for 1+ to 4+ MR respectively, p <0.01 for all). In conclusion, higher grades of MR in patients with STEMI undergoing primary PCI are associated with worse short- and long-term outcomes.
缺血性二尖瓣反流（IMR）与心肌梗死预后较差相关。然而，二尖瓣反流（MR）的严重程度及其对接受直接经皮冠状动脉介入治疗（PCI）的ST段抬高型心肌梗死（STEMI）患者的影响仍不清楚。我们试图确定IMR严重程度增加对接受直接PCI的STEMI患者预后的影响。纳入了1994年至2014年期间所有出现STEMI且在症状出现后12小时内接受直接PCI的患者。在首次心肌梗死后3天内通过超声心动图将IMR分为0至4+级。总体而言，纳入了4005例STEMI患者。无MR、1+、2+、3+和4+级MR的患者分别有3200例（79.9%）、427例（10.7%）、260例（6.5%）、91例（2.3%）和27例（0.7%）。多因素逻辑回归分析显示，更严重的MR与年龄较大、女性、较低的体重指数、贫血、下壁STEMI以及较长的门球时间相关。随着MR分级增加，30天死亡率分别为6.8%、7.3%、8.8%、19.8%和26.1%。无MR至4+级MR的1年死亡率分别为10.8%、12.4%、20.8%、37.4%和37.1%，而5年死亡率分别为16.2%、23.1%、36.5%、53.8%和63%（所有p<0.001）。多因素分析校正年龄、性别、合并症、射血分数和休克后，IMR严重程度与长期死亡率的增加效应相关（1+至4+级MR的风险比分别为1.42、1.83、2.41和2.95，所有p<0.01）。总之，接受直接PCI的STEMI患者中较高等级的MR与较差的短期和长期预后相关。
