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Background <p>Ischemic Mitral Regurgitation (IMR) is a well-established predictor of adverse outcomes following myocardial infarction (MI). Early identification of patients at risk for new-onset mitral regurgitation (MR) after acute coronary syndrome (ACS) could improve long-term risk stratification and guide targeted interventions. We aimed to develop and validate a clinical prediction model for new-onset MR in ACS patients during follow-up.</p> Methods <p>In this retrospective cohort study, 1,024 ACS patients were included. Patients without MR at discharge (<i>N</i> = 556) were further analyzed. Clinical, laboratory, electrocardiographic (ECG), angiographic, and echocardiographic data were analyzed. Multivariable Cox regression was used to identify predictors of new-onset MR. A nomogram was developed and validated using the receiver-operating characteristic curve (ROC) and the calibration curve.</p> Results <p>Among 556 ACS patients without MR at discharge, 108 (19.4%) developed new-onset MR during a median follow-up duration of 12 months. Multivariable analysis identified six independent predictors: female sex (HR 2.988, 95% CI 1.774–5.031), higher peak CK-MB max (HR 1.003 per U/L, 95% CI 1.001–1.004), prolonged QRS duration (HR 1.017 per ms, 95% CI 1.006–1.028), right coronary artery involvement (HR 1.572, 95% CI 1.041–2.375), lack of revascularization (HR 4.356, 95% CI 1.456–13.037), and larger left ventricle diameter (HR 1.055 per mm, 95% CI 1.012–1.099) (all <i>P</i> &lt; 0.05). The prediction model showed good discrimination (concordance index (C-index) 0.754, 95%CI 0.705–0.802) and calibration.</p> Conclusions <p>A novel clinical model incorporating female sex, myocardial injury markers (CK-MB), ECG parameters (QRS duration), right coronary disease, left ventricular remodeling, and revascularization status effectively predicted new-onset MR post-ACS.</p>

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A predictive model for new-onset mitral regurgitation in ACS patients

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年2月24日

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  • Yuanya Liu,
  • Yuqianhui Gong,
  • Xuansheng Huang,
  • Tong Liu,
  • Zidi Wu,
  • Jie Sun,
  • Liting Zhang,
  • Yanxiang Sun

摘要

Background

Ischemic Mitral Regurgitation (IMR) is a well-established predictor of adverse outcomes following myocardial infarction (MI). Early identification of patients at risk for new-onset mitral regurgitation (MR) after acute coronary syndrome (ACS) could improve long-term risk stratification and guide targeted interventions. We aimed to develop and validate a clinical prediction model for new-onset MR in ACS patients during follow-up.

Methods

In this retrospective cohort study, 1,024 ACS patients were included. Patients without MR at discharge (N = 556) were further analyzed. Clinical, laboratory, electrocardiographic (ECG), angiographic, and echocardiographic data were analyzed. Multivariable Cox regression was used to identify predictors of new-onset MR. A nomogram was developed and validated using the receiver-operating characteristic curve (ROC) and the calibration curve.

Results

Among 556 ACS patients without MR at discharge, 108 (19.4%) developed new-onset MR during a median follow-up duration of 12 months. Multivariable analysis identified six independent predictors: female sex (HR 2.988, 95% CI 1.774–5.031), higher peak CK-MB max (HR 1.003 per U/L, 95% CI 1.001–1.004), prolonged QRS duration (HR 1.017 per ms, 95% CI 1.006–1.028), right coronary artery involvement (HR 1.572, 95% CI 1.041–2.375), lack of revascularization (HR 4.356, 95% CI 1.456–13.037), and larger left ventricle diameter (HR 1.055 per mm, 95% CI 1.012–1.099) (all P < 0.05). The prediction model showed good discrimination (concordance index (C-index) 0.754, 95%CI 0.705–0.802) and calibration.

Conclusions

A novel clinical model incorporating female sex, myocardial injury markers (CK-MB), ECG parameters (QRS duration), right coronary disease, left ventricular remodeling, and revascularization status effectively predicted new-onset MR post-ACS.