The influence of severe mitral regurgitation on major adverse cardiac and cerebrovascular events after myocardial infarction in 1-year follow-up: Data from PL-ACS registry.

Abstract

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.