OBJECTIVE: Ischemic mitral regurgitation impacts patient survival and quality of life due to left ventricular remodeling post-myocardial infarction. However, effective treatment strategies for this condition, particularly in the setting of acute coronary syndrome, remain insufficiently evidenced. In this article, we provide treatment references for the management of ischemic mitral regurgitation in patients with acute coronary syndrome. METHODS: In this single-center retrospective study, we evaluated patients with ischemic mitral regurgitation who underwent coronary revascularization for acute coronary syndrome without concurrent mitral valve surgery. Patients were categorized into 2 groups based on mitral regurgitation severity: grade II (grade II ischemic mitral regurgitation, n = 117) and grade III-IV (grade III or IV ischemic mitral regurgitation, n = 40). The primary end point was the improvement in mitral regurgitation severity at 2 years. RESULTS: Baseline characteristics did not differ significantly between the groups. Ischemic mitral regurgitation significantly improved in the grade II group compared with the grade III-IV group (70.9% vs 30%, P <
.002). Multivariate analyses revealed that left ventricular reverse remodeling (odds ratio, 5.712
95% CI, 1.716-19.046
P = .005) and effective management of congestive heart failure (odds ratio, 3.900
95% CI, 1.322-11.501
P = .01) were significant predictors of ischemic mitral regurgitation improvement in the grade II group. However, there were no significant predictors of ischemic mitral regurgitation improvement in the grade III-IV group, including left ventricular reverse remodeling (odds ratio, 6.302
95% CI, 0.476-71.800
P = .17). CONCLUSIONS: In patients with acute coronary syndrome and ischemic mitral regurgitation, coronary revascularization alone was insufficient for treating advanced ischemic mitral regurgitation, grade III or IV, necessitating additional treatment options for ischemic mitral regurgitation.