Mitral Regurgitation and Prognosis After Non‐ST‐Segment Elevation Myocardial Infarction in Very Old Patients

Abstract

Background/Objetctives Mitral regurgitation (MR)after an acute coronary syndrome is associated with a poor prognosis. However,the prognostic impact of MR in elderly patients with non‐ST‐segment elevation myocardialinfarction (NSTEMI) has not been well addressed. Design Prospective registry. Setting and participants The multicenter LONGEVO‐SCA prospective registry included 532 unselected NSTEMI patients aged ≥80 years. Measurements MR was quantified using echocardiography during admission in 497 patients. They were classified in two groups: significant (moderate or severe) or not significant MR (absent or mild). We evaluated the impact of MR status on mortality or readmission at 6 months. Results Mean age was 84.3±4.1 years, and 308 (61.9%) were males. A total of 108 patients (21.7%) had significant MR. Compared with those without significant MR, they were older and showed worse baseline clinical status, with higher frailty, disability, and risk of malnutrition. They also had lower systolic blood pressure, higher heart rate, worse Killip class, lower left ventricular ejection fraction, and higher pulmonary pressure on admission, as well as more often new onset atrial fibrillation (all p values = 0.001). Patients with significant MR also had higher in‐hospital mortality (4.6% vs. 1.3%, p = 0.04), longer hospital stay (median 8 [5‐12] vs. 6 [4‐10] days, p = 0.002), and higher mortality/readmission at 6 months (hazard ratio 1.54, 95% confidence interval 1.09‐2.18, p = 0.015). However, after adjusting for potential confounders, this last association was not significant. Conclusions Significant MR is seen in one fifth of octogenarians with NSTEMI. Patients with significant MR have a poor prognosis, mainly determined by their baseline clinical characteristics. J Am Geriatr Soc 67:1641–1648, 2019

Update on surgical repair in functional mitral regurgitation

“…19 Moderate/severe MR is common after HF and AMI, which was reported in 16%-43% of patients. [20][21][22][23] In China, 4 million people had been estimated to be living with HF and by 2030 the country is estimated to have over 23 million patients with AMIs each year (nearly three times as many as that in 2010). [24][25][26] In HF and AMI cohorts, moderate or severe FMR affects up to 30% of Chinese patients.…”

“…The prevalence of symptomatic HF is estimated to range from 1% to 2% in the general European population 19 . Moderate/severe MR is common after HF and AMI, which was reported in 16%–43% of patients 20–23 . In China, 4 million people had been estimated to be living with HF and by 2030 the country is estimated to have over 23 million patients with AMIs each year (nearly three times as many as that in 2010) 24–26 .…”

Update on surgical repair in functional mitral valve regurgitation.

“…19 Moderate/severe MR is common after HF and AMI, which was reported in 16-43% of patients. [20][21][22][23] In China, 4 million people had been estimated to be living with HF and by 2030 the country is estimated to have over 23 million patients with AMIs each year (nearly 3 times as many as those in 2010). [24][25][26] In HF and AMI cohorts, moderate or severe FMR affects up to 30% of patients.…”

Known–Unknowns in Geriatric Cardiology

“…Data regarding the elderly subjects are limited, although it is proven that the coexistence of AS and CAD leads to a worse prognosis compared to that for an AS of comparable severity occurring alone [54,66]. Moreover, significant MR is observed in one-fifth of the octogenarians with non-ST elevation myocardial infarction, with poor prognosis [67,68].…”