Right ventricular dysfunction is an independent predictor for mortality in ST-elevation myocardial infarction patients presenting with cardiogenic shock on admission.
OBJECTIVE
Despite improvement in prognosis for ST-elevation myocardial infarction (STEMI) patients, mortality remains high in STEMI patients presenting with cardiogenic shock (CS). Right ventricular (RV) dysfunction is an established independent predictor for adverse prognosis in STEMI patients without CS. The purpose of our study was to determine the prognostic value of RV dysfunction on admission in STEMI patients presenting in CS.


RESULTS
Two hundred and ninety-two consecutive STEMI patients with CS on admission were treated by primary percutaneous coronary intervention (PCI) from January 1997 through March 2005. RV function was assessed by measurement of tricuspid annular plane systolic excursion (TAPSE) on early echocardiography in 184 of 292 patients. Right ventricular dysfunction was defined as a TAPSE of <or=14 mm. Right ventricular dysfunction was present on early echocardiography in 70 of 184 patients (38%). The Kaplan-Meier estimate for overall 4-year survival was 57%. Kaplan-Meier estimates for 4-year survival in patients with and without RV dysfunction were 33 and 73%, respectively (P< 0.001). Cox-regression analysis revealed a hazard ratio of 2.1 (95% CI 1.3-3.4, P = 0.002) for RV dysfunction when adjusted for age, glucose on admission, and LVEF < 40%. In patients with and without RV dysfunction, the right coronary artery was the infarct-related artery in 41 and 28% of patients, respectively (P = 0.06).


CONCLUSIONS
In STEMI patients presenting with CS on admission and treated with primary PCI, RV dysfunction as assessed by echocardiography is an independent predictor for long-term mortality.
Engström
Annemarie E
AE
Department of Cardiology, Academic Medical Center, Meibergdreef 9, Amsterdam 1105 AZ, The Netherlands.
Vis
Marije M
MM
Bouma
Berto J
BJ
van den Brink
Renée B A
RB
Baan
Jan
J
Claessen
Bimmer E P M
BE
Kikkert
Wouter J
WJ
Sjauw
Krischan D
KD
Meuwissen
Martijn
M
Koch
Karel T
KT
de Winter
Robbert J
RJ
Tijssen
Jan G P
JG
Piek
Jan J
JJ
Henriques
José P S
JP
D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D015331:Cohort Studies; D016001:Confidence Intervals; D005260:Female; D006760:Hospitalization; D006801:Humans; D007297:Inpatients / Q000706:statistics & numerical data; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications* / Q000000981:diagnostic imaging / Q000401:mortality* / Q000628:therapy; D009426:Netherlands; D011379:Prognosis; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012770:Shock, Cardiogenic / Q000150:complications* / Q000175:diagnosis / Q000401:mortality*; D014463:Ultrasonography; D018497:Ventricular Dysfunction, Right / Q000000981:diagnostic imaging / Q000401:mortality*