Cardiovascular disease (CVD) is the number one cause of death in industrialized nations. Survival rates after acute myocardial infarction (MI) have dramatically improved over the past decade with mortality was decreasing to 4-8% from 30% in the 1980s due to rapid revascularization and improved medical treatment. CVD and moderate leaking of the mitral valve, known as mitral regurgitation (MR), have dismal prognosis, with 5-year survival rates under 50% in patients undergoing coronary artery bypass graft (CABG) surgery. Today more patients with CVD are referred for percutaneous coronary interventions (PCI), such as stents, and their long-term outcomes after revascularizations in patients with moderate MR has not been well defined.
Therefore, we examined 711 patients retrospectively who underwent PCI at the Minneapolis Heart Institute at Abbott Northwestern Hospital in the year 2000 and had qualitative assessment of MR by left ventriculography and/or echocardiography. MR severity was divided into 3 strata: none (n=420, 59%), mild (n=209, 29%), and moderate to severe (n=82, 12%). Patients with progressively more severe MR were older, more frequently female, had a lower left ventricular ejection fraction, had a higher incidence of previous MI, and higher creatinine (all p<0.003). Patients with increasing MR severity (none versus mild versus moderate-severe MR) undergoing PCI had significantly decreased survival rates at 5 years (97%, 83.3%, 57.5%; p<0.0001 respectively). Further study will be needed to evaluate whether concomitant valve repair or CABG with repair would improve outcome in patients with moderate to severe MR requiring revascularization.
Pastorius, Catherine A., "Long-Term Outcomes of Patients with Mitral Regurgitation Undergoing Percutaneous Coronary Intervention" (2006). Honors Projects. Paper 2.
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