Impact of mechanical reperfusion on clinical outcome in elderly patients with right ventricular infarction.
BACKGROUND
Previous reports suggest that elderly patients with acute right ventricular infarction suffer in-hospital mortality of 50% and that hemodynamic compromise is irreversible. We hypothesized that mechanical reperfusion would improve such outcomes.


METHODS
We retrospectively analyzed in-hospital morbidity and mortality in 54 patients >70 years of age with acute inferior myocardial infarction undergoing primary angioplasty. The presence of right ventricular infarction was determined by a two dimensional echocardiogram.


RESULTS
Overall, 18 (33%) patients had inferior myocardial infarction and right ventricular infarction, whereas 36 (67%) patients had inferior myocardial infarction alone. All patients with inferior myocardial infarction alone were successfully reperfused, whereas one patient with right ventricular infarction suffered reperfusion failure. Right ventricular infarction patients more commonly suffered hemodynamic and arrhythmic complications (hypotension in 33 vs. 2.8%, P<0.01; ventricular arrhythmias in 61 vs. 25%, P<0.01; and bradyarrhythmias in 78 vs. 25%, P<0.01). Overall, 72% of right ventricular infarction patients survived, including many with hemodynamic compromise. In-hospital mortality, however, was greater in those with right ventricular infarction than in those without (28 vs. 8.3%, P=0.19).


CONCLUSIONS
Elderly patients with inferior myocardial infarction complicated by right ventricular infarction suffer greater morbidity and mortality than those without. With successful mechanical reperfusion, however, the majority survives, including those with hemodynamic compromise.
Hanzel
George S
GS
Division of Cardiology, William Beaumont Hospital, Royal Oak, Michigan 48073, USA.
Merhi
William M
WM
O'Neill
William W
WW
Goldstein
James A
JA
D000368:Aged; D016009:Chi-Square Distribution; D004452:Echocardiography; D005260:Female; D006352:Heart Ventricles / Q000503:physiopathology; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D009203:Myocardial Infarction / Q000000981:diagnostic imaging / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D015425:Myocardial Reperfusion / Q000379:methods*; D012189:Retrospective Studies; D016896:Treatment Outcome; D018497:Ventricular Dysfunction, Right / Q000000981:diagnostic imaging / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*