Key result
Primary percutaneous coronary intervention for first acute STEMI was associated with a significantly lower incidence of moderate or severe ischemic mitral regurgitation compared to medical management (OR 0.208).
Why the study?
Does primary percutaneous coronary intervention reduce the incidence of ischemic mitral regurgitation in patients with first acute ST-elevated myocardial infarction?
Cohort (n=318)
No
Does primary percutaneous coronary intervention reduce the incidence of ischemic mitral regurgitation in patients with first acute ST-elevated myocardial infarction?
Odds Ratio: 0.208 (95% CI 0.096–0.451)
Absolute Event Rate: 9.9% vs 24.5%
Absolute Risk Reduction: 14.6%
p-value: p=<0.001
Primary PCI for first acute STEMI significantly reduces the incidence of moderate or severe ischemic mitral regurgitation and is associated with improved long-term survival compared to medical management alone.
BACKGROUND: The impact of primary percutaneous coronary intervention (PCI) for acute ST-elevated myocardial infarction (STEMI) on the incidence of ischemic mitral regurgitation (IMR) is unclear. METHODS AND RESULTS: Between January 2000 and December 2004, 318 patients presenting with first acute STEMI were enrolled in this study. Two hundred and twelve (66.67%) patients received PCI (PCI group), and 106 age- and Killip class-matched patients received medical management (non-PCI group). The median duration of follow up was 40.46 months. Compared to the non-PCI group, the PCI group had 14.6% (9.9% vs 24.5%) fewer patients with moderate or severe IMR (P<0.001). Univariate analysis demonstrated IMR was significantly associated with advanced age, higher Killip score, and posterior myocardial infarction (MI). Moreover, IMR was strongly associated with a lower left ventricular (LV) ejection fraction, larger left atrial dimension (LAd), and a larger LV end-systolic and LV end-diastolic volumes (LVEDV) (all P<0.01). Multivariate analysis revealed the odds of IMR in the PCI group was 0.208 times those of the non-PCI group (P<0.001). Additionally, moderate or severe IMR was independently correlated with advanced age, inferior MI, Killip class ≥3, larger LAd, and larger LVEDV (all P<0.05). Furthermore, long-term survival time was longer in the PCI group without IMR than in the non-PCI group with IMR (all P<0.01). CONCLUSIONS: PCI for first acute STEMI was associated with lower incidence of IMR. Advanced age, inferior MI, Killip class ≥3, larger LAd and LVEDV were risk factors associated with IMR development.
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Chua et al. (2010) conducted a cohort in Acute ST-elevated myocardial infarction (STEMI) (n=318). Primary percutaneous coronary intervention (PCI) vs. Medical management was evaluated on Incidence of moderate or severe ischemic mitral regurgitation (IMR) (OR 0.208, 95% CI 0.096-0.451, p=<0.001). Primary percutaneous coronary intervention for first acute STEMI was associated with a significantly lower incidence of moderate or severe ischemic mitral regurgitation compared to medical management (OR 0.208).
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