The full content of Annals is available to subscribers

Subscribe/Learn More  >
Articles |

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, Author, and Disclosure 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
Text Size: A A A

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.





Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).


Submit a Comment/Letter
Submit a Comment/Letter

Summary for Patients

Clinical Slide Sets

Terms of Use

The In the Clinic® slide sets are owned and copyrighted by the American College of Physicians (ACP). All text, graphics, trademarks, and other intellectual property incorporated into the slide sets remain the sole and exclusive property of the ACP. The slide sets may be used only by the person who downloads or purchases them and only for the purpose of presenting them during not-for-profit educational activities. Users may incorporate the entire slide set or selected individual slides into their own teaching presentations but may not alter the content of the slides in any way or remove the ACP copyright notice. Users may make print copies for use as hand-outs for the audience the user is personally addressing but may not otherwise reproduce or distribute the slides by any means or media, including but not limited to sending them as e-mail attachments, posting them on Internet or Intranet sites, publishing them in meeting proceedings, or making them available for sale or distribution in any unauthorized form, without the express written permission of the ACP. Unauthorized use of the In the Clinic slide sets will constitute copyright infringement.


Buy Now for $42.00

to gain full access to the content and tools.

Want to Subscribe?

Learn more about subscription options

Related Articles
Topic Collections
PubMed Articles
Forgot your password?
Enter your username and email address. We'll send you a reminder to the email address on record.