Prevalence and Mortality of Moderate or Severe Mitral Regurgitation Among Patients Undergoing Percutaneous Coronary Intervention With or Without Heart Failure: Results From CIN Study With 28,358 Patients

Haozhang Huang, Jin Liu, Kunming Bao, Xiaoyu Huang, Dehua Huang, Haiyan Wei, Nuerbahaer Remutula, Tilakezi Tuersun, Wenguang Lai, Qiang Li, Bo Wang, Yibo He, Heyin Yang, Shiqun Chen, Jiyan Chen, Kaihong Chen, Ning Tan, Xiaoyan Wang, Liling Chen, Yong Liu, Haozhang Huang, Jin Liu, Kunming Bao, Xiaoyu Huang, Dehua Huang, Haiyan Wei, Nuerbahaer Remutula, Tilakezi Tuersun, Wenguang Lai, Qiang Li, Bo Wang, Yibo He, Heyin Yang, Shiqun Chen, Jiyan Chen, Kaihong Chen, Ning Tan, Xiaoyan Wang, Liling Chen, Yong Liu

Abstract

Aim: This study investigated the prevalence and mortality associated with moderate or severe mitral regurgitation (MR) among patients undergoing percutaneous coronary intervention (PCI), with or without heart failure (HF).

Methods: We analyzed patients undergoing PCI without mitral valve surgery from the Cardiorenal ImprovemeNt (CIN) study (ClinicalTrials.gov NCT04407936). Patients without echocardiography to determine MR occurrence or lacking follow-up death data were excluded. Primary endpoints were 1-year and long-term all-cause mortality, with a median follow-up time of 5 years (interquartile range: 3.1-7.6).

Results: Of 28,358 patients undergoing PCI treatment [mean age: 62.7 ± 10.7; women: 6,749 (25.6%)], 3,506 (12.4%) had moderate or severe MR, and there was a higher rate of moderate or severe MR in HF group than non-HF group (28.8 vs. 5.6%, respectively). Regardless of HF conditions, patients with moderate or severe MR were older and had worse cardio-renal function and significantly increased 1-year mortality [adjusted hazard ratio (aHR): 1.82, 95% confidence interval (CI): 1.51-2.2], and long-term mortality [aHR: 1.43, 95% CI: 1.3-1.58]. There was no significant difference between patients with HF and those with non-HF (P for interaction > 0.05).

Conclusion: One-eighth of the patients undergoing PCI had moderate or severe MR. Furthermore, one-third and one-seventeenth experienced moderate or severe MR with worse cardiorenal function in the HF and non-HF groups, and increased consistent mortality risk. Further studies should explore the efficacy of mitral interventional procedures for moderate or severe MR after PCI treatment, regardless of HF.

Keywords: coronary artery disease; heart failure; moderate or severe mitral regurgitation; mortality; percutaneous coronary intervention; prevalence.

Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Copyright © 2022 Huang, Liu, Bao, Huang, Huang, Wei, Remutula, Tuersun, Lai, Li, Wang, He, Yang, Chen, Chen, Chen, Tan, Wang, Chen and Liu.

Figures

Figure 1
Figure 1
Flow of participants through the trial.
Figure 2
Figure 2
Kaplan-Meier curves for long-term all-cause mortality among different groups according to heart failure (HF) and mitral regurgitation (MR) severity. (A) Total. (B) HF. (C) Non-HF.
Figure 3
Figure 3
Subgroup analysis of moderate or severe MR among in patients undergoing percutaneous coronary intervention (PCI) without mitral valve surgery. Model 3 for long-term mortality. *LVEF #LVEF <47(median among HF).
Figure 4
Figure 4
Central illustration.

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