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Reperfusion therapies reduce ischemic mitral regurgitation following inferoposterior ST-segment elevation myocardial infarction.
MedLine Citation:
PMID:  23103758     Owner:  NLM     Status:  Publisher    
BACKGROUND: The presence of ischemic mitral regurgitation (IMR) after ST-segment elevation myocardial infarction (STEMI) portends a poorer prognosis. The possible influence of reperfusion therapy in restoring mitral valve competence in inferoposterior STEMI has not been well elucidated. METHODS AND RESULTS: We studied 423 consecutive patients with a first inferoposterior STEMI and determined the presence of IMR in patients treated with reperfusion therapy versus medical therapy. A primary percutaneous coronary intervention (PCI) was performed in 186 patients; 74 patients underwent thrombolysis, 63 patients had rescue PCI whereas 54 patients were treated medically. The mean time interval between STEMI presentation and echocardiography was 14±27 days. Patients receiving reperfusion therapy had less moderate or severe IMR (2.5 vs. 11.1%, P=0.001). The presence of IMR between the primary PCI and the thrombolytic groups was similar (52.2 vs. 60.8%, P=NS). Left ventricular ejection fraction (47.7±10.3 vs. 53.1±11.4%, P<0.001) and infarct size (mean CK-MB) (271±168 vs. 222±151 U/l, P<0.001) were significantly worse in patients with IMR. Dominance of the coronary artery system, involvement of the right or the left coronary arteries, and the presence of triple-vessel disease did not correlate with the presence of IMR. After adjustment for age and left ventricular ejection fraction, there was a trend toward poorer survival and recurrent admission for heart failure at 1 year in patients with IMR (hazard ratio=2.4, 95% confidence interval 0.91-6.2, P=0.08). CONCLUSION: Both thrombolytic therapy and primary PCI were associated with decreased incidences of IMR following inferoposterior STEMI.
Kian-Keong Poh; Glenn K Lee; Li-Ching Lee; Eric Chong; Boon-Lock Chia; Tiong-Cheng Yeo
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2012-10-25
Journal Detail:
Title:  Coronary artery disease     Volume:  -     ISSN:  1473-5830     ISO Abbreviation:  Coron. Artery Dis.     Publication Date:  2012 Oct 
Date Detail:
Created Date:  2012-10-29     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9011445     Medline TA:  Coron Artery Dis     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
aDepartment of Medicine, Yong Loo Lin School of Medicine, National University of Singapore bCardiac Department, National University Heart Centre cDepartment of Medicine, National University Health System dDepartment of Medicine, Alexandra Hospital, Jurong Health, Singapore eDepartment of Cardiology, Penang Medical College, Penang, Malaysia.
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