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Outcome of Patients Sustaining Acute Ischemic Mitral Regurgitation during Myocardial Infarction

James E. Tcheng, MD; John D. Jackman Jr., MD; Charlotte L. Nelson, MS; Laura H. Gardner, BS; L. Richard Smith, PhD; J. Scott Rankin, MD; Robert M. Califf, MD; and Richard S. Stack, MD
[+] Article and Author Information

Grant Support: In part by grants HL-36587, HL-45702, and HL-17670 from the National Heart, Lung, and Blood Institute, Bethesda, Maryland; grants HS-05635 and HS-06503 from the Agency for Health Care Policy and Research, Rockville, Maryland; grant G08 LM-04613 from the National Library of Medicine, Bethesda, Maryland; and a grant from the Robert Wood Johnson Foundation, Princeton, New Jersey.

Requests for Reprints: James E. Tcheng, MD, Box 3275, Duke University Medical Center, Durham, NC 27710.

Current Author Addresses: Dr. Tcheng: Box 3275, Duke Medical Center, Durham, NC 27710.

Dr. Jackman: Box 31136, Duke Medical Center, Durham, NC 27710. Ms. Nelson and Ms. Gardner: Box 3850, Duke Medical Center, Durham, NC 27710.

Dr. Smith: Box 3391, Duke Medical Center, Durham, NC 27710.

Dr. Rankin: Box 0118, UCSF Medical Center, 505 Parnaussus, San Francisco, CA 94104.

Dr. Califf: Box 31123, Duke Medical Center, Durham, NC 27710.

Dr. Stack: Box 3111, Duke Medical Center, Durham, NC 27710.


© 1992 American College of PhysiciansAmerican College of Physicians


Ann Intern Med. 1992;117(1):18-24. doi:10.7326/0003-4819-117-1-18
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Objective: To describe outcomes of patients sustaining an acute myocardial infarction complicated by mitral regurgitation managed with contemporary reperfusion therapies.

Design: Inception cohort case study. Long-term follow-up was obtained in 99% of all patients.

Setting: University referral center.

Patients: A series of 1480 consecutive patients presenting between April 1986 and March 1989 who had emergency cardiac catheterization within 6 hours of infarction. Fifty patients were found to have moderately severe or severe mitral regurgitation.

Outcome Measures: Mortality; follow-up cardiac catheterization in patients with regurgitation.

Results: Acute ischemic moderately severe to severe (3 + or 4 +) mitral regurgitation was associated with a mortality of 24% at 30 days (95% Cl, 12% to 36%), 42% at 6 months (Cl, 28% to 56%), and 52% at 1 year (Cl, 38% to 66%); multivariable analysis identified 3 + or 4 + mitral regurgitation as a possible independent predictor of mortality (P = 0.06). Patients with mitral regurgitation tended to be female, older, and to have cerebrovascular disease, diabetes, and preexisting symptomatic coronary artery disease. A physical examination did not identify 50% of patients with moderately severe to severe regurgitation. Acute reperfusion with thrombolysis or angioplasty did not reliably reverse valvular incompetence. In this observational study, the greatest in-hospital and 1-year mortalities were seen in patients reperfused with emergency balloon angioplasty, whereas patients managed medically or with coronary bypass surgery had lower mortalities.

Conclusions: Moderately severe to severe (3 + or 4 +) mitral regurgitation complicating acute myocardial infarction portends a grave prognosis. Acute reperfusion does not reduce mortality to levels experienced by patients with lesser degrees of mitral regurgitation nor does it reliably restore valvular competence.

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