Reperfusion therapies reduce ischemic mitral regurgitation following inferoposterior ST-segment elevation myocardial infarction

Poh, Kian‐Keong; Lee, Glenn K.; Lee, Li‐Ching; Chong, Eric; Chia, B.L.; Yeo, Tiong‐Cheng

doi:10.1097/mca.0b013e32835aab65

Cited by 10 publications

(3 citation statements)

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“…dence of IMR. 24) Hwang and colleagues revealed that revascularization of the right coronary territory resolved IMR early postoperatively. 25) The results from Xiaotian and colleagues indicated that revascularization of the inferior-posterior segments, rather than anterior segments or multisegments, might resolve IMR by gradually improving regional wall motion, reversing regional dilatation, and lessening posterior papillary muscle tethering.…”

Section: Discussionmentioning

confidence: 99%

Risk Factors for Moderate or More Residual Regurgitation in Patients with Moderate Chronic Ischemic Mitral Regurgitation Undergoing Surgical Revascularization Alone

Zhao

Shen

et al. 2019

Int. Heart J.

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Few reports have focused on which patients with moderate ischemic mitral regurgitation (IMR) were not good candidates for coronary artery bypass grafting (CABG) alone. This single-center study aimed to assess risk factors for moderate or more residual regurgitation within two years after CABG alone for the treatment of moderate chronic IMR to optimize the operation strategy and prognosis. A total of 189 eligible patients were entered into a failure group (n = 108) or an improved group (n = 81) according to whether moderate or more residual regurgitation occurred within two years after surgery. Baseline and surgical characteristics were analyzed, and clinical outcomes were compared between groups. Prior myocardial infarction (MI)/chronic myocardial ischemia and region wall motion abnormality (anterior/inferior-posterior wall) were two independent risk factors for moderate or more residual regurgitation, following CABG alone, for the treatment of moderate chronic IMR (OR = 3.15, 95% CI 1.66-5.75, and OR = 2.45, 95% CI 1.36-4.84, respectively). During a median follow-up of 40 months, compared with the improved group, the failure group was more likely to present with New York Heart Association (NYHA) class III-IV and cardiac re-hospitalization (57.4% versus 11.1%, P < 0.001, and 13.9% versus 4.9%, P = 0.043, respectively) and had worse cumulative survival (χ 2 = 4.259, log-rank P = 0.039). Patients suffering from moderate chronic IMR secondary to prior MI (rather than chronic ischemia) with anterior wall motion abnormalities (rather than inferior-posterior wall motion abnormalities) may not be good candidates for CABG alone, and may have a poor prognosis after CABG alone.

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Section: Discussionmentioning

confidence: 99%

Risk Factors for Moderate or More Residual Regurgitation in Patients with Moderate Chronic Ischemic Mitral Regurgitation Undergoing Surgical Revascularization Alone

Zhao

Shen

et al. 2019

Int. Heart J.

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“…Our study is consistent with many previous studies. Poh and colleagues 15 reported that revascularization therapy after posterior-inferior STsegment elevation MI was associated with a lower incidence of IMR. Hwang and colleagues 16 proved that right coronary territory revascularization resolved IMR early postoperatively.…”

Section: Left Ventricular Regional Remodelingmentioning

confidence: 97%

Predictors of moderate ischemic mitral regurgitation improvement after off-pump coronary artery bypass

Sun

Shi

Huang

et al. 2015

The Journal of Thoracic and Cardiovascular Surgery

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In selected patients, preoperative moderate ischemic mitral regurgitation was relieved by off-pump coronary artery bypass grafting. Greater ejection fraction, greater posterior-inferior volume ratio, and early operation timing after infarction may predict the improvement of moderate ischemic mitral regurgitation after off-pump coronary artery bypass grafting, suggesting that posterior-inferior regional remodeling, reserved ventricular function, and early revascularization are important to the outcome.

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“…This disparity is explained by the different methods utilized for assessing IMR, the heterogeneity of studied populations, and different reperfusion utilized techniques [1-18]. In addition, some of this data is based on secondary analysis of clinical trials [1,9,10,12,13], which are subject to referral and selection biases, while others assessed and quantified the severity of IMR in the subacute time period [2-6,16,17]. Finally, of these studies, only a minority was based on modern primary PCI strategy [3,9,15,18].…”

Section: Introductionmentioning

confidence: 99%

Predictors and prognosis of early ischemic mitral regurgitation in the era of primary percutaneous coronary revascularisation

MacHaalany

Bertrand

O’Connor

et al. 2014

Cardiovasc Ultrasound

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BackgroundStudies assessing ischemic mitral regurgitation (IMR) comprised of heterogeneous population and evaluated IMR in the subacute setting. The incidence of early IMR in the setting of primary PCI, its progression and clinical impact over time is still undetermined. We sought to determine the predictors and prognosis of early IMR after primary percutaneous coronary intervention (PCI) for ST-elevation myocardial infarction (STEMI).MethodsUsing our primary PCI database, we screened for patients who underwent ≥2 transthoracic echocardiograms early (1–3 days) and late (1 year) following primary PCI. The primary outcomes were: (1) major adverse events (MACE) including death, ischemic events, repeat hospitalization, re-vascularization and mitral repair or replacement (2) changes in quantitative echocardiographic assessments.ResultsFrom January 2006 to July 2012, we included 174 patients. Post-primary PCI IMR was absent in 95 patients (55%), mild in 60 (34%), and moderate to severe in 19 (11%). Early after primary PCI, IMR was independently predicted by an ischemic time > 540 min (OR: 2.92 [95% CI, 1.28 – 7.05]; p = 0.01), and female gender (OR: 3.06 [95% CI, 1.42 – 6.89]; p = 0.004). At a median follow-up of 366 days [34–582 days], IMR was documented in 44% of the entire cohort, with moderate to severe IMR accounting for 15%. During follow-up, MR regression (change ≥ 1 grade) was seen in 18% of patients. Moderate to severe IMR remained an independent predictor of MACE (HR: 2.58 [95% CI, 1.08 – 5.53]; p = 0.04).ConclusionsAfter primary PCI, IMR is a frequent finding. Regression of early IMR during long-term follow-up is uncommon. Since moderate to severe IMR post-primary PCI appears to be correlated with worse outcomes, close follow-up is required.

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Reperfusion therapies reduce ischemic mitral regurgitation following inferoposterior ST-segment elevation myocardial infarction

Abstract: Both thrombolytic therapy and primary PCI were associated with decreased incidences of IMR following inferoposterior STEMI.

Cited by 10 publications

References 0 publications

Risk Factors for Moderate or More Residual Regurgitation in Patients with Moderate Chronic Ischemic Mitral Regurgitation Undergoing Surgical Revascularization Alone

Risk Factors for Moderate or More Residual Regurgitation in Patients with Moderate Chronic Ischemic Mitral Regurgitation Undergoing Surgical Revascularization Alone

Predictors of moderate ischemic mitral regurgitation improvement after off-pump coronary artery bypass

Predictors and prognosis of early ischemic mitral regurgitation in the era of primary percutaneous coronary revascularisation

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