Key result
Residual IMR after recurrent MI is linked to ~22% higher MACE risk per 1-mm vena contracta increase.
Why the study?
The prognostic impact of ischemic mitral regurgitation in recurrent myocardial infarction remains poorly defined.
Observational (n=88)
No
Hazard Ratio: 1.22 (95% CI 1.08–1.38)
p-value: p=0.001
In patients with recurrent myocardial infarction, residual ischemic mitral regurgitation and reduced LVEF at discharge independently predict 5-year adverse cardiovascular outcomes.
Serial IMR monitoring in recurrent MI may refine risk stratification; leaves open whether targeted intervention alters prognosis in observational data.
Background: The prognostic impact of ischemic mitral regurgitation (IMR) in recurrent myocardial infarction (MI) remains poorly defined. This study evaluated dynamic changes in IMR during recurrent MI and determined prognostic implications. Methods and Results: We retrospectively reviewed 4,091 patients who underwent primary percutaneous coronary intervention for acute MI between May 2008 and July 2022. Of these patients, 88 experienced a second MI and underwent transthoracic echocardiography at 3 time points: before recurrent MI, at onset, and at discharge. IMR severity was assessed using mean vena contracta width. Logistic regression was used to determine predictors of persistent IMR, and Cox analysis was used to evaluate 5-year adverse outcomes (a composite of all-cause death, heart failure hospitalization, and third MI). IMR worsened at the onset of recurrent MI and remained elevated at discharge (P<0.001). Older age, lower left ventricular ejection fraction (LVEF), and greater IMR severity at onset independently predicted persistent IMR. In multivariable Cox analysis, residual IMR (per 1-mm increase: hazard ratio [HR] 1.22; 95% confidence interval [CI] 1.08–1.38) and reduced LVEF (per 1% decrease: HR 0.95; 95% CI 0.92–0.98) were independently associated with a higher risk of 5-year adverse events. Conclusions: IMR changes dynamically during recurrent MI and often persists despite acute treatment. Residual IMR and reduced LVEF predicted long-term adverse outcomes, highlighting the importance of residual IMR assessment for risk stratification.
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Nishino et al. (2026) conducted an observational in Recurrent myocardial infarction (n=88). Residual ischemic mitral regurgitation (per 1-mm increase in vena contracta width) vs. No/trivial residual ischemic mitral regurgitation was evaluated on Major adverse cardiac events (MACE), defined as a composite of all-cause death, heart failure hospitalization, and recurrent (third) myocardial infarction at 5 years (HR 1.22, 95% CI 1.08-1.38, p=0.001). Residual ischemic mitral regurgitation after recurrent myocardial infarction was independently associated with a higher risk of 5-year adverse events, with a 22% increased risk per 1-mm increase in vena contracta width.
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