Vyas Pooja, Dake Radhakishan, Kanabar Kewal, Patel Iva, Mishra Ashish, Sharma Vishal, Nathwani Tirth, Parwani Kunal, Rathod Mital
Department of Cardiology, U. N. Mehta Institute of Cardiology and Research Centre (UNMICRC), Civil Hospital Campus, Gujarat - Índia.
Champavati Medicare Heart and Critical Care Hospital, Beed, Maharashtra - Índia.
Arq Bras Cardiol. 2024 Nov;121(12):e20240064. doi: 10.36660/abc.20240064.
The optimal treatment for ischemic mitral regurgitation (IMR) in patients of non-ST elevation myocardial infarction (NSTEMI) is a debated topic.
To evaluate the long term outcome on patients with NSTEMI and IMR, particularly emphasizing the comparison of treatments in those with moderate to severe MR.
We enrolled patients with NSTEMI and classified non/trivial to mild regurgitation as insignificant IMR and moderate to severe regurgitation as significant IMR. Furthermore, patients with substantial IMR were assessed for long-term clinical outcomes with respect to different management strategies. A test was considered statistically significant based on the probability value p<0.05.
From a total of 4,189 patients of NSTEMI, significant IMR was found in 7.21% of patients. A significantly higher number of patients with death (1.21% vs. 13.24%, p<0.0001), cardiogenic shock (0.46% vs. 13.24%, p<0.0001) and heart failure (1.03% vs. 11.59%, p<0.0001) were found during hospitalization in patients with significant IMR. At a 2-year follow-up, a higher event rate was observed in the significant IMR group. Patients with significant IMR re-vascularized either by percutaneous coronary intervention (PCI), coronary artery bypass grafting (CABG), or CABG+ mitral valve (MV) surgery showed substantial improvement in MR grade ( 32.65% vs. 6% vs. 16.98%, p<0.0001) and LVEF (27.55% vs. 1% vs. 1.89%, p<0.0001) at 1 year follow up and significantly improved outcomes were identified compared to refused revascularization and medical management group with (-5.10% vs. 15% vs. 13.21%, p=0.04) mortality, (-33.67% vs. 61% vs. 73.58%, p<0.0001) readmission, and (-15.31% vs. 27% vs. 33.96%, p=0.01) heart failure at 2 years follow up.
Higher mortality and admission rates were observed in patients with significant IMR compared to those with in-significant IMR. Notably, significant IMR patients who underwent PCI, CABG, or CABG+MV surgery showed improved outcomes compared to non-revascularized counterparts.
非ST段抬高型心肌梗死（NSTEMI）患者缺血性二尖瓣反流（IMR）的最佳治疗方法是一个有争议的话题。
评估NSTEMI和IMR患者的长期预后，特别强调对中重度二尖瓣反流患者不同治疗方法的比较。
我们纳入了NSTEMI患者，并将无/微量至轻度反流归类为无意义的IMR，中重度反流归类为有意义的IMR。此外，对有大量IMR的患者根据不同的管理策略评估其长期临床结局。基于概率值p<0.05，检验被认为具有统计学意义。
在总共4189例NSTEMI患者中，7.21%的患者存在有意义的IMR。有意义的IMR患者在住院期间死亡（1.21%对13.24%，p<0.0001）、心源性休克（0.46%对13.24%，p<0.0001）和心力衰竭（1.03%对11.59%，p<0.0001）的发生率显著更高。在2年的随访中，有意义的IMR组观察到更高的事件发生率。接受经皮冠状动脉介入治疗（PCI）、冠状动脉旁路移植术（CABG）或CABG+二尖瓣（MV）手术再血管化的有意义的IMR患者在1年随访时二尖瓣反流分级（32.65%对6%对16.98%，p<0.0001）和左心室射血分数（LVEF）（27.55%对1%对1.89%，p<0.0001）有显著改善，与拒绝再血管化和药物治疗组相比，在2年随访时死亡率（-5.10%对15%对13.21%，p=0.04）、再入院率（-33.67%对61%对73.58%，p<0.0001）和心力衰竭发生率（-15.31%对27%对33.96%，p=0.01）有显著改善。
与无意义的IMR患者相比，有意义的IMR患者观察到更高的死亡率和入院率。值得注意的是，与未进行再血管化的患者相比，接受PCI、CABG或CABG+MV手术的有意义的IMR患者结局有所改善。
