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Impact of right ventricular involvement on mortality and morbidity in patients with inferior myocardial infarction.

Abstract：

OBJECTIVES:We sought to evaluate the prognostic impact of right ventricular (RV) myocardial involvement in patients with inferior myocardial infarction (MI). BACKGROUND:There is uncertainty regarding the risk of major complications in patients with inferior MI complicated by RV myocardial involvement. Whether these complications are related to RV myocardial involvement itself or simply to the extent of infarction involving the left ventricle (LV) is also unknown. METHODS:We examined the incidence of death and mechanical and electrical complications in patients with (n = 491) and without (n = 638) RV myocardial involvement and in patients with anterior MI (n = 971) in an analysis from the Collaborative Organization for RheothRx Evaluation (CORE) trial. Left ventricular infarct size was assessed by technetium-99m-sestamibi single-photon emission computed tomography and peak creatine kinase, and LV function was assessed by radionuclide angiography. We also performed a meta-analysis in which we pooled the results of our study with previous smaller studies addressing the same question. RESULTS:Six-month mortality was 7.8% in inferior MI compared with 13.2% in anterior MI. Among patients with inferior MI, serious arrhythmias were significantly more common in patients with RV myocardial involvement who also had a trend toward higher mortality, pump failure and mechanical complications. However, this was not associated with a difference in LV infarct size or function. A meta-analysis of six studies (n = 1,198) confirmed that RV myocardial involvement was associated with an increased risk of death (odds ratio [OR] 3.2, 95% confidence interval [CI] 2.4 to 4.1), shock (OR 3.2, 95% CI 2.4 to 3.5), ventricular tachycardia or fibrillation (OR 2.7, 95% CI 2.1 to 3.5) and atrioventricular block (OR 3.4, 95% CI 2.7 to 4.2). CONCLUSIONS:Patients with inferior MI who also have RV myocardial involvement are at increased risk of death, shock and arrhythmias. This increased risk is related to the presence of RV myocardial involvement itself rather than the extent of LV myocardial damage.

journal_name

J Am Coll Cardiol

journal_title

Journal of the American College of Cardiology

authors

Mehta SR,Eikelboom JW,Natarajan MK,Diaz R,Yi C,Gibbons RJ,Yusuf S

doi

10.1016/s0735-1097(00)01089-5

subject

Has Abstract

pub_date

2001-01-01 00:00:00

pages

37-43

issue

eissn

0735-1097

issn

1558-3597

pii

S0735-1097(00)01089-5

journal_volume

pub_type

临床试验,杂志文章,meta分析,多中心研究,随机对照试验

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Impact of right ventricular involvement on mortality and morbidity in patients with inferior myocardial infarction.