Risk Factors And Prediction Models For Persistent Moderate And Severe Mitral Regurgitation In Post-Percutaneous Coronary Intervention Patients

Background:Patients with moderate and severe mitral regurgitation complicated with coronary artery disease(CAD)still have persistent moderate and severe mitral regurgitation after percutaneous coronary intervention(PCI).This process is closely related to some risk factors,but data are scarce.To determine risk Factors and prediction models for persistent significant sMR(grade≥2)in post-PCI patients to enable early identification and positive intervention.Methods:PCI patients with baseline moderate and severe sMR,either not accepting mitral valve surgery at baseline or within the echocardiographic follow-up window were included from a multi-center cohort study.Major clinical outcome was a composite of worsening heart failure(HF)and unplanned mitral valve surgery.The median follow-up was 3.6 years.Results:Among the 920 participants,366(39.8%)still had moderate or severe sMR following PCI.Patients in the persistent significant sMR group had a higher incidence of worsening HF or unplanned mitral valve surgery(27.6%vs.9.6%;adjusted hazard ratio[aHR]:3.00;95%CI:2.10-4.29)than those in the improvement group.In a multivariable model,advanced age,congestive HF,hypertension,atrial fibrillation,anemia,thinner left ventricular wall thickness,dilated left atrium,increased mitral regurgitation level,higher levels of troponin,and use of β-blockers were independent predictors of persistent significant sMR(C-index:0.71).Conclusions:Moderate or severe sMR can be improved after PCI treatment in some but not all patients:persistent significant sMR is still common(approximately 40%)in PCI patients and significantly increased by a 2-fold risk of worsening HF or unplanned mitral valve surgery.The identified predictors may help identify patients at risk of post-PCI persistent significant sMR.