Acute right ventricular infarction: clinical spectrum, results of reperfusion therapy and short-term prognosis.
BACKGROUND
The role of thrombolytic therapy (TT) and percutaneous coronary interventions (PCIs) in subgroups of patients with right ventricular infarction (RVI) has not been evaluated.


RESULTS
We risk-stratified 302 patients with RVI into three subsets upon admission. Class A (n=197) comprised patients without right ventricular (RV) failure, Class B (n=69) with RV failure and Class C (n=36) with cardiogenic shock. All eligible patients in Class A or B received either PCI or TT. Patients in Class C eligible for reperfusion were treated with PCI. All patients were evaluated for in-hospital major adverse cardiac events and short-term mortality. There was a statistically significant difference in in-hospital mortality among the classes. Classes B and C were the strongest indicators of in-hospital mortality. By multivariate analysis TT or PCI did not reduce mortality in Classes A and B, but a clinically favorable trend in mortality reduction was documented: both methods decreased RV dysfunction in Class B (from 97% to 61% with TT and to 28% with PCI; P < 0.001) and PCI reduced the risk of mortality in Class C (89.5% compared with 58%; P < 0.05).


CONCLUSIONS
Classification into types A, B or C allows the prediction of mortality. The use of TT or PCI suggests a clinical favorable trend in the reduction of mortality in Class A, either is beneficial in Class B for decreasing morbidity and PCI appears to be the most appropriate procedure for Class C since it reduced mortality.
Lupi-Herrera
Eulo
E
Coronary Care Unit, Instituto Nacional de Cardiología Ignacio Chavez, Mexico City, Mexico. archivos@cardiologia.org.mx
Lasses
Luis Alberto
LA
Cosio-Aranda
Jorge
J
Chuquiure-Valenzuela
Eduardo
E
Martínez-Sánchez
Carlos
C
Ortiz
Patricio
P
González-Pacheco
Héctor
H
Juárez-Herrera
Ursulo
U
Rodriguez
María del Carmen López
Mdel C
Vargas-Barrón
Jesús
J
Martínez-Rios
Marco Antonio
MA
D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D001783:Blood Flow Velocity; D015897:Comorbidity; D017023:Coronary Angiography; D003326:Coronary Circulation; D004452:Echocardiography; D005260:Female; D006333:Heart Failure / Q000175:diagnosis / Q000401:mortality; D006352:Heart Ventricles / Q000503:physiopathology; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000145:classification* / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D015425:Myocardial Reperfusion / Q000379:methods*; D012770:Shock, Cardiogenic / Q000175:diagnosis / Q000401:mortality; D016019:Survival Analysis; D015912:Thrombolytic Therapy; D016896:Treatment Outcome