Mitral Regurgitation and Prognosis After Non-ST-Segment Elevation Myocardial Infarction in Very Old Patients

Pablo Díez-Villanueva, Alberto Vera, Albert Ariza-Solé, Oriol Alegre, Francesc Formiga, Ramon López-Palop, Francisco Marín, María T. Vidán, Manuel Martínez-Sellés, Jorge Salamanca, Alessandro Sionis, Héctor García-Pardo, Héctor Bueno, Juan Sanchís, Emad Abu-Assi, Violeta González-Salvado, Isaac Llaó, Fernando Alfonso

    Research output: Contribution to journalArticleResearch

    3 Citations (Scopus)

    Abstract

    © 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.
    Original languageEnglish
    Pages (from-to)1641-1648
    JournalJournal of the American Geriatrics Society
    Volume67
    DOIs
    Publication statusPublished - 1 Jan 2019

    Keywords

    • frailty
    • mitral regurgitation
    • non-ST-segment elevation myocardial infarction
    • octogenarians

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