Ładziński Szymon, Niedziela Jacek, Witkowski Adam, Bartuś Stanisław, Lesiak Maciej, Milewski Krzysztof, Gierlotka Marek, Trzeciak Przemysław, Gąsior Mariusz, Wojakowski Wojciech
Division of Cardiology and Structural Heart Diseases, Medical University of Silesia, Katowice, Poland.
3rd Department of Cardiology, Silesian Center for Heart Diseases, Medical University of Silesia, Katowice, Poland.
Kardiol Pol. 2023;81(6):572-579. doi: 10.33963/KP.a2023.0064. Epub 2023 Mar 16.
Mitral regurgitation (MR) is frequently observed in patients with myocardial infarction (MI). However, the incidence of severe MR in the contemporary population is unknown.
The study evaluates the prevalence and prognostic impact of severe MR in the contemporary population of patients with ST-segment elevation myocardial infarction (STEMI) and non-ST-segment elevation myocardial infarction (NSTEMI).
The study group consisted of 8062 patients enrolled in the Polish Registry of Acute Coronary Syndromes (PL-ACS) in the years 2017-2019. Only the patients with full echocardiography performed during the index hospitalization were eligible. The primary composite outcome was 12-month major adverse cardiac and cerebrovascular events (MACCE) (death, non-fatal myocardial infarction, stroke, and heart failure [HF] hospitalization) compared between patients with and without severe MR.
5561 NSTEMI patients and 2501 STEMI patients were enrolled in the study. Severe MR occurred in 66 (1.19%) NSTEMI patients and 30 (1.19%) STEMI patients. Multivariable regression models demonstrated that severe MR is an independent risk factor for all-cause death in 12-month follow-up (odds ratio [OR], 1.839; 95% confidence interval [CI], 1.012-3.343; P = 0.046) in all MI patients. Patients with NSTEMI and severe MR had higher mortality (22.7% vs. 7.1%), HF rehospitalization rate (39.4% vs. 12.9%), and MACCE occurrence (54.5% vs. 29.3%). Severe MR was associated with higher mortality (20% vs. 6%) and higher HF rehospitalization rate (30% vs. 9.8%), stroke (10% vs. 0.8%), and MACCE rates (50% vs. 23.1%) in STEMI patients.
Severe MR is associated with higher mortality and MACCE occurrence in patients with MI in 12-month follow-up. Severe MR is an independent risk factor for all-cause death.
二尖瓣反流（MR）在心肌梗死（MI）患者中很常见。然而，当代人群中严重MR的发生率尚不清楚。
本研究评估当代ST段抬高型心肌梗死（STEMI）和非ST段抬高型心肌梗死（NSTEMI）患者中严重MR的患病率及其对预后的影响。
研究组由2017年至2019年纳入波兰急性冠状动脉综合征注册研究（PL-ACS）的8062例患者组成。仅纳入在首次住院期间进行了完整超声心动图检查的患者。主要复合结局是比较有和没有严重MR的患者之间的12个月主要不良心脑血管事件（MACCE）（死亡、非致命性心肌梗死、中风和心力衰竭[HF]住院）。
5561例NSTEMI患者和2501例STEMI患者纳入本研究。66例（1.19%）NSTEMI患者和30例（1.19%）STEMI患者发生严重MR。多变量回归模型显示，在所有MI患者中，严重MR是12个月随访中全因死亡的独立危险因素（比值比[OR]，1.839；95%置信区间[CI]，1.012-3.343；P = 0.046）。NSTEMI合并严重MR的患者死亡率更高（22.7%对7.1%）、HF再住院率更高（39.4%对12.9%）以及MACCE发生率更高（54.5%对29.3%）。严重MR与STEMI患者更高的死亡率（20%对6%）、更高的HF再住院率（30%对9.8%）、中风发生率（10%对0.8%）以及MACCE发生率（50%对23.1%）相关。
在12个月的随访中，严重MR与MI患者更高的死亡率和MACCE发生率相关。严重MR是全因死亡的独立危险因素。
