Mild or greater tricuspid regurgitation at discharge is associated with a 1.87-fold higher risk of major adverse cardiac events over 6 years post-AMI (p=0.048).
Does the presence of mild or greater tricuspid regurgitation at discharge worsen long-term clinical outcomes in patients following first-onset acute myocardial infarction treated with primary PCI?
The presence of even mild tricuspid regurgitation at discharge following primary PCI for acute myocardial infarction is an independent predictor of long-term major adverse cardiac events.
Absolute Event Rate: 0% vs 0%
Abstract Background The prognosis of patients after acute myocardial infarction (AMI) has greatly improved with the widespread use of early reperfusion therapy by primary percutaneous coronary intervention (PCI). The availability of less invasive percutaneous interventions for tricuspid regurgitation (TR) has focused attention on the prognostic impact of TR. The clinical impact of TR in patients following AMI is largely unknown. Purpose The aim of this study was to clarify the prevalence and prognostic impact of TR in post-AMI patients treated with appropriate primary PCI. Methods Three hundred fifty-one consecutive patients with first-onset AMI who underwent successful primary PCI from July 2014 to December 2018 were retrospectively examined. Standard two- and three-dimensional echocardiography were performed at discharge. Based on the presence or absence of mild or greater TR, patients were divided into TR (+) and TR (-) groups, respectively. The primary outcome was the incidence of major adverse cardiac events (MACE), defined as the composite of death, re-hospitalization for congestive heart failure, and recurrent MI. Results Seventy-eight (22.2%) patients had mild or greater TR. Kaplan–Meier analysis showed that the cumulative 6-year incidence of MACE was significantly higher in the TR (+) group (hazard ratio, 2.56 95% confidence interval, 1.48–4.44; p0.001) (Figure 1A). In the analysis of the severity of TR, the prognosis of patients with mild TR was significantly worse than that of patients without TR (long-rank p=0.022) (Figure 1B). Multivariable analysis revealed that older age (≥65 years old), reduced left ventricular ejection fraction (50%), and mild or greater ischemic mitral regurgitation were independent predictors of mild or greater TR at discharge. Following adjustment for significant clinical parameters, mild or greater TR at discharge was still associated with a significant hazard ratio for the occurrence of MACE (1.87, 95% confidence interval, 1.01–3.48; P=0.048) (Figure 2). Conclusions The presence of mild or greater TR at discharge may serve as a poor prognostic marker in patients with first-onset AMI. In addition to traditional clinical risk factors, it is important to pay more attention to TR and to manage it appropriately.Six-year Kaplan-Meier curves for MACE Multivariable analysis for MACE
Nishino et al. (Sat,) reported a other. Mild or greater tricuspid regurgitation at discharge is associated with a 1.87-fold higher risk of major adverse cardiac events over 6 years post-AMI (p=0.048).