A proposed functional clinical classification predicts in-hospital and long-term survival in the setting of acute right ventricular infarction.
BACKGROUND
The objectives of the present investigation were to validate the prognostic role of a proposed Clinical Classification [CC], to evaluate the TIMI risk score [RS] and to establish whether the TIMI-RS should incorporate points for patients with acute right ventricular infarction [TIMI-RS-RVI].


RESULTS
A total of 523 RVI patients were classified on clinical and functional basis as: A, without right ventricular failure [RVF], B with RVF and C with cardiogenic shock. The CC was evaluated prospectively among 98 patients with RVI and retrospectively in 425 RVI patients. The TIMI-RS was evaluated prospectively among 622 patients with STEMI [anterior:277, inferior:247, RVI:98], and retrospectively in 425 RVI patients. The CC established differences among the 3-RVI Classes for in-hospital mortality [prospectively and retrospectively; p<0.01, p<0.001, respectively] that were maintained at 8 years [p < 0.001]. Patients with anterior and inferior STEMI, but not those with RVI revealed an association between outcome and TIMI-RS [p<0.001]. Testing for TIMI-RS-RVI did not result a good prognostic tool [ROC=0.9; excellent discrimination, but with a very poor "clinical calibration"].


CONCLUSIONS
The proposed CC allowed prediction of mortality at short- and long-term in the setting of acute RVI. The role of the TIMI-RS should be reevaluated prospectively as a prognostic tool in the scenario of RVI patients.
Lupi-Herrera
Eulo
E
Instituto Nacional de Cardiologia Ignacio Chavez, Mexico City, Mexico. eulo.lupi@cardiologia.org.mx
Chuquiure-Valenzuela
Eduardo
E
González-Pacheco
Hector
H
Juárez-Herrera
Ursulo
U
Martínez-Sánchez
Carlos
C
Gaspar
Jorge
J
D000368:Aged; D000704:Analysis of Variance; D017052:Hospital Mortality; D006801:Humans; D008875:Middle Aged; D009203:Myocardial Infarction / Q000145:classification / Q000401:mortality / Q000503:physiopathology; D011446:Prospective Studies; D012189:Retrospective Studies; D018570:Risk Assessment; D012770:Shock, Cardiogenic / Q000401:mortality / Q000503:physiopathology; D015912:Thrombolytic Therapy; D018497:Ventricular Dysfunction, Right / Q000145:classification / Q000401:mortality / Q000503:physiopathology