Clinical profile and outcome of first acute myocardial infarction with ischemic mitral regurgitation.

BACKGROUND Ischemic mitral regurgitation indicates a poor prognosis after acute myocardial infarction (AMI). This study addresses the clinical characteristics and contribution of ischemic mitral regurgitation to the midterm survival rate of patients following first AMI in our institution. METHODS Between January 2000 and December 2002, patients who underwent 2-dimensional color Doppler echocardiographic quantitation of ischemic mitral regurgitation within 30 days after first myocardial infarction (MI) were analyzed. RESULTS During the study period, 519 patients were enrolled (mean age 62.7 +/- 12 years, 76% men). The population was divided into 2 groups based on the degree of mitral regurgitation (MR). Group A included 440 subjects with no MR (n = 41), trivial MR (n = 188), and mild MR (n = 211). Group B included 79 subjects with moderate MR (n = 64), and severe MR (n = 15). Group B patients were more likely to be older (p < 0.05), women (p < 0.01), and nonsmokers (p < 0.01). Group B had a higher prevalence of inferior wall MI (p < 0.01) and lateral wall MI (p < 0.01). After 6 months of follow-up, 57 deaths had occurred (42 in Group A and 15 in Group B). Group B had a lower survival rate than Group A 180 days post-AMI (19% vs. 9.79%, p < 0.01). CONCLUSIONS Post-AMI patients with significant ischemic mitral regurgitation were more likely to be older, female, and nonsmokers. There was a positive association between the severity of ischemic mitral regurgitation and inferior MI and lateral wall MI. The severity of ischemic mitral regurgitation showed a significant inverse relationship with the mid-term post-MI survival rate.