Prevalence and prognostic impact of tricuspid regurgitation following LAD and LCX related STEMI
D Guz, L Perl, Y Shapira, K Orvin, T Bental, R Kornowski, M VaturiAbstract
Background
Risk stratification of patients with ST-elevation myocardial infarction (STEMI) focuses primarily on left ventricular ejection fraction (LVEF) and ischemic mitral regurgitation, whereas the prognostic role of tricuspid regurgitation (TR) remains poorly defined, particularly following LAD or LCX-related infarction.
Purpose
The purpose of this study is to investigate the association of TR in LAD and LCX-STEMI and to assess its short and long-term prognostic impact.
Methods
We conducted a retrospective, single-center cohort study of patients presenting with a first LAD or LCX-related STEMI (2000-2019) treated with primary percutaneous coronary intervention. Patients with prior myocardial infarction, revascularization, or significant valvular disease were excluded. Transthoracic echocardiography was performed during hospitalization and follow-up. Moderate-to-severe TR was considered clinically significant. The primary prognostic endpoint was time to all-cause mortality. Secondary endpoints included in-hospital mortality and 1-year major adverse cardiovascular events (MACE).
Results
Among 1,273 patients with LAD (n=981) or LCX (n=292) culprit lesions, moderate-to-severe TR was common and more frequently associated with LAD-related infarction (31.6% vs 24.7%, p = 0.02). Moderate-to-severe TR was consistently associated with higher all-cause mortality in both LAD (22% vs 9%) and LCX infarctions (21% vs 7%), as well as higher in-hospital mortality and 1-year MACE (all p<0.01). In multivariable analysis, TR remained independently associated with mortality after adjusting for age, infarct size, and left ventricular systolic function (HR 1.81, 95% CI 1.29-2.53; p<0.001). Among patients with TR, concomitant right ventricular dysfunction (RVD) identified a particularly high-risk phenotype, with more than two-fold higher mortality (risk ratio of 2.28, 95% CI 1.44-3.63; p=0.0052).
Conclusions
TR early after LAD or LCX-related STEMI is frequent and independently associated with adverse outcomes, particularly when accompanied by RVD, highlighting its importance in post-STEMI risk stratification.visual abstract