Inferior wall myocardial infarction with or without right ventricular involvement--treatment and in-hospital course.
BACKGROUND
Right ventricular infarction (RVI) is most commonly associated with inferior wall infarction (20-50% of cases). Clinical presentation of RVI may vary.


OBJECTIVE
Assessment of outcome and clinical course of myocardial infarction in patients with inferior wall myocardial infarction with or without RVI. Additionally, risk stratification was attempted in the above-mentioned groups of patients.


METHODS
The analysis involved 181 consecutive patients (pts) with inferior wall myocardial infarction hospitalised between 1 July 2000 and 1 July 2002.


RESULTS
Nineteen in-hospital deaths were noted in the study group (mortality 10.5%), reinfarction occurred in 6 (3.3%) pts, ischaemic stroke in 1 (0.6%) patient, and 2 (1.1%) pts had transient ischaemic attack. Cardiogenic shock occurred in 20 (11.0%) pts , ventricular fibrillation in 15 (8.3%) pts, and pulmonary oedema in 9 (4.9%) pts. In the subgroup of 161 pts without cardiogenic shock 8 (4.9%) pts died. Thrombolytic therapy was administered in 96 (53%) subjects. Isolated inferior wall myocardial infarction was diagnosed in 94 (51.9%) of 181 pts and RVI in 65 (35.9%) pts. Mortality rate in the RVI group was significantly higher than in inferior wall myocardial infarction without RVI and was 18.5% vs 2.12% (p=0.0003), respectively (excluding patients with cardiogenic shock: 11.1% vs 1.2%, respectively; p=0.016). In patients with RVI aged above 70 years, the mortality rate was significantly higher than in younger patients (32% vs 10%, p=0.002). In a subgroup with RVI treated with thrombolysis mortality was considerably higher in subjects aged >70 years compared to patients below 70 years (38.5% vs 7.7%, p=0.017).


CONCLUSIONS
RVI is associated with worse prognosis and increased number of in-hospital complications. Older patients aged >70 years have definitely poorer prognosis. Thrombolytic therapy in a subgroup of older patients with RVI remains ineffective.
Kukla
Piotr
P
Oddział Wewnetrzny, Szpital Specjalistyczny, ul. Wegierska 21, 38-300 Gorlice, Poland. kukla_piotr@poczta.onet.pl
Dudek
Dariusz
D
Rakowski
Tomasz
T
Dziewierz
Artur
A
Mielecki
Waldemar
W
Szczuka
Kazimierz
K
Dubiel
Jacek S
JS
D000367:Age Factors; D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000379:methods; D015897:Comorbidity; D004452:Echocardiography / Q000379:methods; D006352:Heart Ventricles / Q000473:pathology; D017052:Hospital Mortality; D006801:Humans; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000000981:diagnostic imaging / Q000401:mortality* / Q000628:therapy*; D015425:Myocardial Reperfusion / Q000379:methods; D011237:Predictive Value of Tests; D011379:Prognosis; D011859:Radiography; D012008:Recurrence; D012189:Retrospective Studies; D016019:Survival Analysis; D015912:Thrombolytic Therapy / Q000379:methods; D016896:Treatment Outcome; D018497:Ventricular Dysfunction, Right / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy*; D016276:Ventricular Function