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CLINICAL STUDIES

Effects of thrombolytic therapy in acute inferior myocardial infarction with or without right ventricular involvement

Uwe Zeymer, MD^*, Karl-Ludwig Neuhaus, MD^*, Karl Wegscheider, PhD^a, Ulrich Tebbe, MD, Peter Molhoek, MD, Rolf Schröder, MD, FACC^a for the HIT-4 Trial Group¹

^a Coordinating Centers of the HIT-4 Trial, Kassel and Berlin, Germany
^* Städtische Kliniken, Kassel, Germany
Klinikum Lippe-Detmold, Detmold, Germany
Medisch Spectrum Twente, Enschede, The Netherlands

Manuscript received January 20, 1998; revised manuscript received May 11, 1998, accepted June 17, 1998.

Address for correspondence: Dr. Rolf Schröder, Universitätsklinikum Benjamin Franklin, Free University Berlin, Hindenburgdamm 30, D-12200 Berlin, Germany

Objectives. This study assessed the prognostic impact of right ventricular involvement (RVI) in streptokinase-treated patients with inferior acute myocardial infarction (AMI) stratified for small or large AMI.

Background. Only scant data exist from small studies about the impact of reperfusion therapy on survival in patients with RVI during inferior AMI.

Methods. Right ventricular involvement was assessed by ST-segment elevation 0.1 mV in lead V₄R and infarct size by the extent of ST-segment deviation on the baseline electrocardiogram: small AMI = sum ST-segment elevation 0.8 mV and no precordial ST-segment depression (small ST); large AMI = presence of precordial ST-segment depression or sum ST-segment elevation >0.8 mV (large ST) in 522 inferior AMI patients of the Hirudin for Improvement of Thrombolysis (HIT-4) Trial. In 187 patients, 90-min coronary angiography was performed.

Results. Right ventricular involvement was present in 169 patients (32%). Higher 30-day cardiac mortality rates with RVI (5.9% vs. 2.5%) were related to larger infarct size rather than to RVI. For large ST, a proximal right coronary artery lesion was observed in 52% with and in 23% without RVI. Patency rates at 90 min were similar (54% vs. 52%). In the 28% of patients who had small ST, cardiac mortality was less than 1% irrespective of the presence of RVI. Coronary artery lesions were mostly located distally. Patency rates were 27% with and 80% without RVI.

Conclusions. ST-segment elevation of 0.1 mV in V₄R in inferior AMI patients is associated with larger infarct size and higher 30-day mortality rates. Right ventricular involvement is not an independent predictor of survival. In patients with small ST, cardiac mortality is low, even if ST V₄R is 0.1 mV.

Abbreviations and Acronyms   AMI = acute myocardial infarction   CK = creatine kinase   ECG = electrocardiogram   HIT = Hirudin for Improvement of Thrombolysis   large ST = Presence of precordial ST-segment depression or ST-segment elevation >0.8 mV   small ST = ST-segment elevation 0.8 mV and no precordial ST-segment depression   RVI = right ventricular involvement

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