Tricuspid regurgitation after left-sided STEMI: an independent marker of adverse prognosis

Background Risk stratification for patients with ST-elevation myocardial infarction (STEMI) primarily focuses on left ventricular ejection fraction (LVEF) and ischemic mitral regurgitation (MR), whereas the prognostic significance of tricuspid regurgitation (TR) after left-sided STEMI remains poorly defined. Methods We retrospectively analyzed consecutive patients presenting with a first LAD- or LCX-related STEMI between 2000 and 2019 who underwent primary percutaneous coronary intervention (PCI). Patients with prior myocardial infarction, revascularization, or significant valvular disease were excluded. Transthoracic echocardiography was performed within 24 h of PCI. Significant TR was defined as at least moderate regurgitation. The primary endpoint was long-term all-cause mortality. Results Among 1,273 patients with left-sided STEMI, moderate or severe TR was present in 74 patients (5.8%). Patients with significant TR had higher all-cause mortality (44.6% vs. 10.8%; p < 0.001), in-hospital mortality (12.2% vs. 1.9%; p < 0.001), and 1-year major adverse cardiovascular events (39.2% vs. 15.3%; p < 0.001). Kaplan-Meier analysis demonstrated significantly lower long-term survival among patients with significant TR (log-rank p < 0.001). After adjustment for age, comorbidities, infarct size, LVEF, MR, and right ventricular dysfunction (RVD), TR remained independently associated with mortality (HR 2.84, 95% CI 1.43–5.6; p = 0.002). Propensity score-matched analysis confirmed these findings. Importantly, TR remained associated with higher long-term all-cause mortality even among patients with preserved LVEF (27.3% vs. 3.7%; p = 0.011). Conclusions Moderate or greater TR after left-sided STEMI is independently associated with adverse outcomes beyond those attributable to reduced LVEF and MR. Clinical trial number Not applicable.