TY - JOUR
T1 - Mitral Regurgitation and Prognosis After Non-ST-Segment Elevation Myocardial Infarction in Very Old Patients
AU - Díez-Villanueva, Pablo
AU - Vera, Alberto
AU - Ariza-Solé, Albert
AU - Alegre, Oriol
AU - Formiga, Francesc
AU - López-Palop, Ramon
AU - Marín, Francisco
AU - Vidán, María T.
AU - Martínez-Sellés, Manuel
AU - Salamanca, Jorge
AU - Sionis, Alessandro
AU - García-Pardo, Héctor
AU - Bueno, Héctor
AU - Sanchís, Juan
AU - Abu-Assi, Emad
AU - González-Salvado, Violeta
AU - Llaó, Isaac
AU - Alfonso, Fernando
N1 - © 2019 The American Geriatrics Society.
PY - 2019/8
Y1 - 2019/8
N2 - © 2019 The American Geriatrics Society Background/Objetctives: Mitral regurgitation (MR)after an acute coronary syndrome is associated with a poor prognosis. However,the prognostic impact of MR in elderly patients with non-ST-segment elevation myocardialinfarction (NSTEMI) has not been well addressed. Design: Prospective registry. Setting and participants: The multicenter LONGEVO-SCA prospective registry included 532 unselected NSTEMI patients aged ≥80 years. Measurements: MR was quantified using echocardiography during admission in 497 patients. They were classified in two groups: significant (moderate or severe) or not significant MR (absent or mild). We evaluated the impact of MR status on mortality or readmission at 6 months. Results: Mean age was 84.3±4.1 years, and 308 (61.9%) were males. A total of 108 patients (21.7%) had significant MR. Compared with those without significant MR, they were older and showed worse baseline clinical status, with higher frailty, disability, and risk of malnutrition. They also had lower systolic blood pressure, higher heart rate, worse Killip class, lower left ventricular ejection fraction, and higher pulmonary pressure on admission, as well as more often new onset atrial fibrillation (all p values = 0.001). Patients with significant MR also had higher in-hospital mortality (4.6% vs. 1.3%, p = 0.04), longer hospital stay (median 8 [5-12] vs. 6 [4-10] days, p = 0.002), and higher mortality/readmission at 6 months (hazard ratio 1.54, 95% confidence interval 1.09-2.18, p = 0.015). However, after adjusting for potential confounders, this last association was not significant. Conclusions: Significant MR is seen in one fifth of octogenarians with NSTEMI. Patients with significant MR have a poor prognosis, mainly determined by their baseline clinical characteristics. J Am Geriatr Soc 67:1641–1648, 2019.
AB - © 2019 The American Geriatrics Society Background/Objetctives: Mitral regurgitation (MR)after an acute coronary syndrome is associated with a poor prognosis. However,the prognostic impact of MR in elderly patients with non-ST-segment elevation myocardialinfarction (NSTEMI) has not been well addressed. Design: Prospective registry. Setting and participants: The multicenter LONGEVO-SCA prospective registry included 532 unselected NSTEMI patients aged ≥80 years. Measurements: MR was quantified using echocardiography during admission in 497 patients. They were classified in two groups: significant (moderate or severe) or not significant MR (absent or mild). We evaluated the impact of MR status on mortality or readmission at 6 months. Results: Mean age was 84.3±4.1 years, and 308 (61.9%) were males. A total of 108 patients (21.7%) had significant MR. Compared with those without significant MR, they were older and showed worse baseline clinical status, with higher frailty, disability, and risk of malnutrition. They also had lower systolic blood pressure, higher heart rate, worse Killip class, lower left ventricular ejection fraction, and higher pulmonary pressure on admission, as well as more often new onset atrial fibrillation (all p values = 0.001). Patients with significant MR also had higher in-hospital mortality (4.6% vs. 1.3%, p = 0.04), longer hospital stay (median 8 [5-12] vs. 6 [4-10] days, p = 0.002), and higher mortality/readmission at 6 months (hazard ratio 1.54, 95% confidence interval 1.09-2.18, p = 0.015). However, after adjusting for potential confounders, this last association was not significant. Conclusions: Significant MR is seen in one fifth of octogenarians with NSTEMI. Patients with significant MR have a poor prognosis, mainly determined by their baseline clinical characteristics. J Am Geriatr Soc 67:1641–1648, 2019.
KW - frailty
KW - mitral regurgitation
KW - non-ST-segment elevation myocardial infarction
KW - octogenarians
UR - http://www.mendeley.com/research/mitral-regurgitation-prognosis-after-nonstsegment-elevation-myocardial-infarction-very-old-patients
U2 - 10.1111/jgs.15926
DO - 10.1111/jgs.15926
M3 - Article
C2 - 31045252
SN - 0002-8614
VL - 67
SP - 1641
EP - 1648
JO - Journal of the American Geriatrics Society
JF - Journal of the American Geriatrics Society
ER -