Coronary revascularization (PCI, CABG, or CABG + MV surgery) significantly reduced the risk of death compared with medical therapy in patients with ischemic mitral regurgitation (HRs 0.58-0.69, P=0.0001).
Cohort (n=2,757)
Does coronary revascularization (PCI or CABG) with or without mitral valve surgery improve survival compared to medical therapy in patients with ischemic mitral regurgitation?
In patients with ischemic mitral regurgitation, revascularization with PCI or CABG is associated with improved survival compared to medical therapy, but adding mitral valve surgery to CABG does not appear to confer an additional survival benefit.
Hazard Ratio: 0.58
p-value: p=0.0001
BACKGROUND: The most appropriate treatment for patients with ischemic mitral regurgitation (IMR) is often debated. We compared the survival rates of patients with IMR undergoing different treatment strategies, namely: medical therapy, percutaneous coronary intervention (PCI), coronary artery bypass grafting (CABG), and CABG + mitral valve (MV) surgery. METHODS AND RESULTS: Patients undergoing catheterization between 1986 and 2001 were included. IMR was defined as: >or=grade 2+ mitral regurgitation (MR) and significant coronary artery disease (CAD) without primary mitral valve disease. Patients undergoing catheterization for the evaluation of congenital or other valvular heart disease were excluded. Multivariable Cox proportional hazards modeling was utilized to assess the independent relation between treatment and survival. Propensity score methods were used to correct for the nonrandom assignment of treatment. Of the 2,757 patients who met study criteria: 1,305 were treated medically, 537 underwent PCI, 687 underwent CABG, and 228 underwent CABG + MV surgery. The median duration of follow-up was 3.2 (0.9, 7.1) years. Patients undergoing CABG + MV surgery had more severe MR and more severe heart failure than those treated by other modalities. After adjusting for differences in baseline characteristics, patients undergoing PCI, CABG, and CABG + MV surgery had a 31% (hazards ratio HR=0.69; P=0.0001), 42% (HR=0.58; P=0.0001), and 42% (HR=0.58; P=0.0001) reduction in the risk of death, respectively, compared with those undergoing medical therapy. The performance of mitral valve surgery with CABG was not associated with improved survival versus CABG alone (P=0.258). CONCLUSIONS: Among patients with IMR, treatment with PCI, CABG, or CABG + MV surgery is associated with improved survival compared with medical therapy.
Trichon et al. (Tue,) conducted a cohort in Ischemic mitral regurgitation (IMR) (n=2,757). Coronary revascularization (PCI, CABG, or CABG + MV surgery) vs. Medical therapy was evaluated on Death (HR 0.58, p=0.0001). Coronary revascularization (PCI, CABG, or CABG + MV surgery) significantly reduced the risk of death compared with medical therapy in patients with ischemic mitral regurgitation (HRs 0.58-0.69, P=0.0001).