RESUMO
Background: Type 2 myocardial infarction (T2MI) was first established as a unique entity in 2007. However, its clinical features are not well characterized. This study aimed to determine the clinical characteristics, predictors of mortality, and hospitalization trends of patients with T2MI. Methods: The National Inpatient Sample database was queried for patients hospitalized in the United States with T2MI (January 2018 to December 2019). Data were used to assess baseline characteristics, primary diagnoses, predictors of mortality, and hospitalization and mortality trends of T2MI. Results: During the 24-month study period, 1,789,485 (76%) patients were admitted with type 1 myocardial infarction (T1MI) and 563,695 (24%) were admitted with T2MI. Patients with T2MI were more likely to be older (71 vs 68 years; P < .001) and female (47.5% vs 38.3%; P < .001), with fewer comorbidities related to coronary atherosclerosis. African Americans were the only race with a significantly higher rate of hospitalization for T2MI (15.9% vs 11.6%; P < .001). The predictors of mortality were similar in both the T2MI and T1MI cohorts. Sepsis (23.47%), hypertensive heart disease (15.35%), and atrial arrhythmias (4.49%) were the most common principal diagnoses for T2MI. T2MI hospitalizations trended consistently upward during the study period. Monthly in-hospital mortality rates were consistently higher for T2MI versus T1MI (P < .001). Conclusions: T2MI is a unique and heterogeneous clinical entity. Despite increased awareness, there is a lack of standardization of medical management and timing for revascularization, even as mortality rates remain persistently elevated compared with T1MI. Certain demographics, including African Americans, may be disproportionately affected.
RESUMO
Background: Patients with severe tricuspid regurgitation carry an elevated surgical risk resulting in increasing adoption of less invasive transcatheter therapies such as transcatheter tricuspid valve repair (TTVR); however, data are limited. This study aimed to describe patient characteristics and predictors of poor outcomes among those undergoing TTVR. Methods: The National Inpatient Sample was queried (2016-2019) to identify all patients undergoing TTVR (International Classification of Diseases, Tenth Revision code 02UJ3JZ) alone or in combination with mitral transcatheter edge-to-edge repair (MTEER) (code 02UG3JZ). The primary aim was to define clinical characteristics, time trends, in-hospital outcomes, and predictors of all-cause in-hospital mortality (mortality). The secondary outcomes included predictors of increased hospitalization costs and length of stay (greater than the 75th percentile). Results: We identified 925 patients who underwent TTVR (460 [49.7%] who underwent TTVR alone and 465 [50.3%] who underwent TTVR in combination with MTEER). There was a 6.5-fold increase in TTVR adoption (P < .001). Patients were older (78 ± 10 years), female (63.2%), and White (72.7%), with frequent comorbidities. Mortality occurred in 2.2%, vascular complications occurred in 10.3%, and major bleeding occurred in 3.3%. The predictors of mortality were acute kidney injury (odds ratio [OR], 5.25; 95% CI, 5.24-5.26; P < .001), major bleeding (OR, 2.81; 95% CI, 2.80-2.83; P < .001), pericardiocentesis (OR, 2.15; 95% CI, 2.11-2.18; P < .001), and chronic liver disease (OR, 1.40; 95% CI, 1.39-1.40; P < .001). The predictors of increased length of stay or hospitalization costs included coronary artery disease, atrial arrhythmias, pulmonary hypertension, chronic liver disease, and procedural complications. Conclusions: TTVR showed increased adoption with elevated but acceptable mortality and complications considering this high-risk population. The results of randomized trials are awaited.