Minneapolis Heart Institute Foundation, Inc.

The long-term natural history of moderate tricuspid regurgitation (TR) patients with preserved left-ventricular ejection fraction (LVEF) and without severe left-sided valvular heart disease (VHD) remains ambiguous. We aimed to assess the outcomes of patients with moderate TR, preserved LVEF and without concomitant severe left-sided VHD.

We evaluated patients diagnosed with moderate TR in our centers between 2012 and 2020. The primary outcome was all-cause death, the secondary outcome was the composite of all-cause death+heart failure (HF) hospitalization, also accounting for pulmonary artery systolic pressure (PASP) values and concomitant moderate left-sided VHD.

Among 1198 moderate TR patients, 53 % had New York Heart Association class ≥II and mean LVEF was 58 ± 5 %. After a median follow-up of 2.9 years, 3-year survival was 69 % (95 % confidence interval [CI]: 66 %-72 %), significantly worse than an age- and gender-matched population (p < 0.001), and 3-year survival free from the secondary composite outcome was 63 % (95 % CI: 60-67 %). At secondary analysis, increasing PASP values were associated with worse adjusted prognosis, and in patients with PASP <35 mmHg 3-year survival free from the primary and secondary outcome was 85 % (95 % CI: 80 %-89 %) and 80 % (95 % CI: 75 %-86 %), respectively. Finally, among patients with concomitant moderate left-sided VHD groups, the group with moderate aortic stenosis+moderate TR presented the worst adjusted prognosis, and patients with isolated moderate TR had a yearly mortality of 8.9 % (95 % CI: 6.0 %-11.0 %).

Our cohort of moderate TR patients, despite having preserved LVEF and no concomitant severe left-sided VHD, presented significant risk of death and of HF hospitalization.

Nonagenarians with ST-elevation myocardial infarction (STEMI) represent a unique and growing population and are underrepresented in clinical trials due to arbitrary exclusion criteria. Therefore, a thorough examination of STEMI in this age population may better inform management decisions.

This is a cohort study examining the Midwest STEMI Consortium database from March 2003 through October 2020. All patients with STEMI, presenting within 24 hours of symptom onset, were enrolled -including those with advanced age, cardiogenic shock, or out-of-hospital cardiac arrest. Data are described across age groups: <70, 70-79, 80-89, and ≥90 years. Main outcome measures were discharge disposition; mortality in-hospital, 30-days, and 1-year.

Among 15,039 consecutive STEMI patients, 303 (2%) were ≥90 years, of whom 194 (64%) were females. Among nonagenarians, mortality was 17% in the hospital, 20% at 30-day, and 33% at 1-year; and those living in a skilled nursing facility (SNF) before presentation had significantly higher in-hospital mortality (36%) versus those living at home or in an assisted living facility (ALF) (14% and 15% respectively). The mortality at 1 year was 13% for patients discharged to home, 20% for those discharged with home health care or ALF, and 43% for those discharged to SNF (P < .001).

In this large multicenter prospective STEMI database, nonagenarians living in SNF before presentation had more than 2-fold higher in-hospital mortality than those living at home. Furthermore, patients discharged to SNF had a 3-fold higher 1-year mortality than those discharged to home. In this older STEMI population, living status before the presentation and at hospital discharge carries important prognostic information.