Prognostic impact of right ventricular involvement in patients with acute myocardial infarction: meta-analysis.
OBJECTIVE
The objective of this study was to examine the relationship between right ventricular involvement (RVI) in acute myocardial infarction (AMI) and the increase in mortality and morbidity frequently suggested in the last two decades.


METHODS
The authors conducted a systematic review and meta-analysis.


METHODS
This study was conducted at an academic medical center.


METHODS
The authors reviewed PubMed, BioMedCentral, and the Cochrane database and conducted a manual review of article bibliographies.


METHODS
Using a prespecified search strategy, 22 relevant studies involving a total of 7,136 patients with AMI at baseline, of whom 1,963 had RVI (27.5%), were included in a meta-analysis using a random effects model. Pooled relative risks of the impact of RVI on patient mortality and morbidity were calculated.


RESULTS
An overall pooled relative risk mortality increase of 2.59 (95% confidence interval, 2.02-3.31) was found (Z = 7.57; p < .00001). RVI in AMI was also associated with a statistically significant increase in all secondary end points assessed, including cardiogenic shock, ventricular arrhythmias, advanced atrioventricular block, and mechanical complications.


CONCLUSIONS
Our results support the view that early recognition of RVI, namely by means of right electrocardiographic leads in acute myocardial infarction, may have prognostic value. Whether or not this recognition will permit improvement of outcomes through more aggressive percutaneous coronary intervention would need to be tested in future studies.
Hamon
Martial
M
Department of Cardiology, University Hospital of Caen & INSERM 744, Institut Pasteur de Lille, Caen, France. hamon-m@chu-caen.fr
Agostini
Denis
D
Le Page
Olivier
O
Riddell
John W
JW
Hamon
Michèle
M
D002986:Clinical Trials as Topic; D004562:Electrocardiography; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000209:etiology* / Q000401:mortality; D011379:Prognosis; D012770:Shock, Cardiogenic / Q000209:etiology* / Q000401:mortality; D018497:Ventricular Dysfunction, Right / Q000150:complications* / Q000175:diagnosis