title: Prognostic importance of right ventricular infarction in an acute myocardial infarction cohort referred for contemporary percutaneous reperfusion therapy.
abstract: BACKGROUND
  Right ventricular (RV) involvement during acute inferior myocardial infarction (MI) is associated with increased early morbidity and mortality. With recent improvement in percutaneous coronary intervention (PCI) techniques, it is unclear which factors may improve the outcomes of these patients. We sought to assess the prognostic significance of the presence of right ventricular myocardial infarction (RV-MI) in patients undergoing primary PCI and to explore factors associated with improved outcomes by using a large database representing the "real life" of patients with acute MI (AMI) treated by primary PCI.
  
  
  METHODS
  We analyzed our database of patients with AMI undergoing primary PCI within 12 hours of chest pain between January 2001 and June 2005, excluding patients with cardiogenic shock.
  
  
  RESULTS
  Of the 666 consecutive patients with MI fulfilling our inclusion criteria, 329 had anterior wall MI, 264 had inferior (230 inferior + 34 lateral) wall MI, and 73 had RV-MI. Mortality at hospital discharge, 30 days, and 6 months was highest in patients with RV-MI involvement (5.5%, 9.6%, and 12.3%, respectively), intermediate in patients with anterior MI (2.4%, 4.6%, and 7.3%, respectively), and lowest in patients without RV myocardial involvement (0.8%, 1.1%, and 3%, respectively) (P < .05 for hospital discharge and 30 days, P = .1 for 6 months). After adjustment for the CADILLAC score, odds ratio for 30-day morbidity was 5.2 (95% CI 1.6-17, P = .005) for patients with RV-MI versus those without RV-MI. Within the group of patients with RV-MI, complete revascularization of the right coronary artery including the major RV branch was associated with higher rate of RV function recovery by echocardiography and improved 30-day mortality (odds ratio 0.4, 95% CI 0.1-1.05, P = .06).
  
  
  CONCLUSIONS
  Right ventricular infarction is an independent risk factor for increased mortality even in these days of primary PCI. Intensive medical therapy including restoring blood flow into the right coronary artery including the major RV branch may improve clinical outcomes.
authors.affiliation: Cardiology Department, The Cardiac Catheterization Laboratories, Rabin Medical Center, Petah Tikva, affiliated to the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel. aassali@clalit.org.il
authors.forename: Abid R
authors.initials: AR
authors.lastname: Assali
authors.forename: Igal
authors.initials: I
authors.lastname: Teplitsky
authors.forename: Itsik
authors.initials: I
authors.lastname: Ben-Dor
authors.forename: Alejandro
authors.initials: A
authors.lastname: Solodky
authors.forename: David
authors.initials: D
authors.lastname: Brosh
authors.forename: Alexander
authors.initials: A
authors.lastname: Battler
authors.forename: Shmuel
authors.initials: S
authors.lastname: Fuchs
authors.forename: Ran
authors.initials: R
authors.lastname: Kornowski
mesh_terms: D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D005260:Female; D006352:Heart Ventricles; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000401:mortality* / Q000628:therapy*; D011379:Prognosis