Mitral Regurgitation and Prognosis After Non-ST-Segment Elevation Myocardial Infarction in Very Old Patients
Por:
Diez-Villanueva, P, Vera, A, Ariza-Sole, A, Alegre, O, Formiga, F, Lopez-Palop, R, Marin, F, Vidan, MT, Martinez-Selles, M, Salamanca, J, Sionis, A, Garcia-Pardo, H, Bueno, H, Sanchis, J, Abu-Assi, E, Gonzalez-Salvado, V, Llao, I, Alfonso, F
Publicada:
1 ago 2019
Resumen:
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
Filiaciones:
Diez-Villanueva, P:
Hosp Univ La Princesa, Madrid, Spain
Vera, A:
Hosp Univ La Princesa, Madrid, Spain
Ariza-Sole, A:
Hosp Univ Bellvitge, Barcelona, Spain
Alegre, O:
Hosp Univ Bellvitge, Barcelona, Spain
Formiga, F:
Hosp Univ Bellvitge, Barcelona, Spain
Lopez-Palop, R:
Hosp Univ San Juan, Cardiol Dept, Alicante, Spain
Marin, F:
Hosp Virgen Arrixaca, Murcia, Spain
Vidan, MT:
Univ Europea, Univ Complutense, Hosp Gen Univ Gregorio Maranon, CIBERCV, Madrid, Spain
Martinez-Selles, M:
Univ Europea, Univ Complutense, Hosp Gen Univ Gregorio Maranon, CIBERCV, Madrid, Spain
Salamanca, J:
Hosp Univ La Princesa, Madrid, Spain
Sionis, A:
Univ Autonoma Barcelona, Hosp Santa Creu & St Pau, Barcelona, Spain
Garcia-Pardo, H:
Hosp Univ Rio Hortega, Valladolid, Spain
Bueno, H:
Hosp Doce Octubre, Madrid, Spain
Ctr Nacl Invest Cardiovasc, Madrid, Spain
Sanchis, J:
Univ Valencia, Hosp Clin Univ Valencia, INCLIVA, CIBER CV, Valencia, Spain
Abu-Assi, E:
Hosp Alvaro Cunqueiro, Vigo, Spain
Gonzalez-Salvado, V:
Hosp Clin Univ Santiago de Compostela, Santiago De Compostela, Spain
Llao, I:
Hosp Univ Bellvitge, Barcelona, Spain
Alfonso, F:
Hosp Univ La Princesa, Madrid, Spain
|