Introduction: In comparison to anterior wall myocardial infarction, inferior wall myocardial infarction is generally regarded as a low risk event. The aim of this study was to evaluate the prognostic impact of right v...Introduction: In comparison to anterior wall myocardial infarction, inferior wall myocardial infarction is generally regarded as a low risk event. The aim of this study was to evaluate the prognostic impact of right ventricular (RV) myocardial involvement in patients with inferior wall myocardial infarction (IWMI). Methods: This is an observational study of 82 consecutive IWMI patients admitted and treated in Manmohan Cardiothoracic, Vascular and Transplant Center (MCVTC) from May 15 2018 to June 15 2019. The clinical characteristics, risk factors profile, electrocardiographic, echocardiographic, including RV function and angiographic characteristics, complications and in-hospital deaths were analyzed. Results: The mean age of patients presenting with IMWI was 64.8 ± 13.8 years with predominance of male (67%). Right ventricular myocardial infarction was present in 34.1% of patient with RV dysfunction in 25.6% patients. Mean Tricuspid Annular Plane Systolic Excursion (TAPSE), RV tricuspid annulus (S') and RV Fractional area change (FAC) in patients with RV dysfunction vs patients without RV dysfunction were 12.2 ± 3.3 mm vs 22.5 ± 3.5 mm (p < 0.001), 7.54 ± 0.91 cm/s vs. 12.79 ± 2.16 cm/s respectively (p Conclusion: In inferior wall myocardial infarction, RV involvement with RV dysfunction is an independent risk factor for in-hospital mortality along with advanced age, complete atrioventricular block, higher Killip class, delayed hospital presentation, left ventricular ejection fraction < 40% and angiographic evidence of triple vessel disease.展开更多
AIM: To investigate the impact of primary reperfusion therapy(RT) on early and late mortality in acute right ventricular infarction(RVI). METHODS: RVI patients(n = 679) were prospectivelyclassified as without right ve...AIM: To investigate the impact of primary reperfusion therapy(RT) on early and late mortality in acute right ventricular infarction(RVI). METHODS: RVI patients(n = 679) were prospectivelyclassified as without right ventricular failure(RVF)(class A, n = 425, 64%), with RVF(class B, n = 158, 24%) or with cardiogenic shock(CS)(class C, n = 96, 12%). Of the 679 patients, 148(21.7%) were considered to be eligible for thrombolytic therapy(TT) and 351(51.6%) for primary percutaneous coronary intervention(PPCI). TIMI 3-flow by TT was achieved for A, B and C RVI class in 65%, 64% and 0%, respectively and with PPCI in 93%, 91% and 87%, respectively. RESULTS: For class A without RT, the mortality rate was 7.9%, with TT was reduced to 4.4%(P < 0.01) and with PPCI to 3.2%(P < 0.01). Considering TT vs PPCI, PPCI was superior(P < 0.05). For class B without RT the mortality was 27%, decreased to 13% with TT(P < 0.01) and to 8.3% with PPCI(P < 0.01). In a TT and PPCI comparison, PPCI was superior(P < 0.01). For class C without RT the in-hospital mortality was 80%, with TT was 100% and with PPCI, the rate decreased to 44%(P < 0.01). At 8 years, the mortality rate without RT for class A was 32%, for class B was 48% and for class C was 85%. When PPCI was successful, the longterm mortality was lower than previously reported for the 3 RVI classes(A: 21%, B: 38%, C: 70%; P < 0.001). CONCLUSION: PPCI is superior to TT and reduces short/long-term mortality for all RVI categories. RVI CS patients should be encouraged to undergo PPCI at a specialized center.展开更多
文摘Introduction: In comparison to anterior wall myocardial infarction, inferior wall myocardial infarction is generally regarded as a low risk event. The aim of this study was to evaluate the prognostic impact of right ventricular (RV) myocardial involvement in patients with inferior wall myocardial infarction (IWMI). Methods: This is an observational study of 82 consecutive IWMI patients admitted and treated in Manmohan Cardiothoracic, Vascular and Transplant Center (MCVTC) from May 15 2018 to June 15 2019. The clinical characteristics, risk factors profile, electrocardiographic, echocardiographic, including RV function and angiographic characteristics, complications and in-hospital deaths were analyzed. Results: The mean age of patients presenting with IMWI was 64.8 ± 13.8 years with predominance of male (67%). Right ventricular myocardial infarction was present in 34.1% of patient with RV dysfunction in 25.6% patients. Mean Tricuspid Annular Plane Systolic Excursion (TAPSE), RV tricuspid annulus (S') and RV Fractional area change (FAC) in patients with RV dysfunction vs patients without RV dysfunction were 12.2 ± 3.3 mm vs 22.5 ± 3.5 mm (p < 0.001), 7.54 ± 0.91 cm/s vs. 12.79 ± 2.16 cm/s respectively (p Conclusion: In inferior wall myocardial infarction, RV involvement with RV dysfunction is an independent risk factor for in-hospital mortality along with advanced age, complete atrioventricular block, higher Killip class, delayed hospital presentation, left ventricular ejection fraction < 40% and angiographic evidence of triple vessel disease.
文摘AIM: To investigate the impact of primary reperfusion therapy(RT) on early and late mortality in acute right ventricular infarction(RVI). METHODS: RVI patients(n = 679) were prospectivelyclassified as without right ventricular failure(RVF)(class A, n = 425, 64%), with RVF(class B, n = 158, 24%) or with cardiogenic shock(CS)(class C, n = 96, 12%). Of the 679 patients, 148(21.7%) were considered to be eligible for thrombolytic therapy(TT) and 351(51.6%) for primary percutaneous coronary intervention(PPCI). TIMI 3-flow by TT was achieved for A, B and C RVI class in 65%, 64% and 0%, respectively and with PPCI in 93%, 91% and 87%, respectively. RESULTS: For class A without RT, the mortality rate was 7.9%, with TT was reduced to 4.4%(P < 0.01) and with PPCI to 3.2%(P < 0.01). Considering TT vs PPCI, PPCI was superior(P < 0.05). For class B without RT the mortality was 27%, decreased to 13% with TT(P < 0.01) and to 8.3% with PPCI(P < 0.01). In a TT and PPCI comparison, PPCI was superior(P < 0.01). For class C without RT the in-hospital mortality was 80%, with TT was 100% and with PPCI, the rate decreased to 44%(P < 0.01). At 8 years, the mortality rate without RT for class A was 32%, for class B was 48% and for class C was 85%. When PPCI was successful, the longterm mortality was lower than previously reported for the 3 RVI classes(A: 21%, B: 38%, C: 70%; P < 0.001). CONCLUSION: PPCI is superior to TT and reduces short/long-term mortality for all RVI categories. RVI CS patients should be encouraged to undergo PPCI at a specialized center.
