CLINICAL STUDY: MYOCARDIAL INFARCTION
Impact of right ventricular involvement on mortality and morbidity in patients with inferior myocardial infarction1
Shamir R. Mehta, MD, FACC*  ,
John W. Eikelboom, MBBS, FRACP,
Madhu K. Natarajan, MD, FACC* ,
Rafael Diaz, MD, FACC ,
Cheelong Yi, MSc, PhD,
Raymond J. Gibbons, MD, FACC and
Salim Yusuf, DPhil, FACC*
* Division of Cardiology, Hamilton Health Sciences Corporation, McMaster University, Hamilton, Canada
Population Health Institute, McMaster University, Hamilton, Canada
Estudios Cardiologicos Latinoamerica, Rosario, Argentina
Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
Manuscript received December 30, 1999;
revised manuscript received August 21, 2000,
accepted September 28, 2000.
Reprint requests and correspondence: Dr. Shamir Mehta, Division of Cardiology, McMaster University Medical Center, 1200 Main Street, West HSC-345, Hamilton, Ontario, Canada L8N325
smehta{at}fhs.mcmaster.ca
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.
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Abbreviations and Acronyms
| | CK | = creatine kinase | | CORE | = Collaborative Organization for RheothRx Evaluation trial | | LV | = left ventricle or ventricular | | MI | = myocardial infarction | | RNA | = radionuclide angiography | | RV | = right ventricular | | 99mTc-sestamibi SPECT | = 99mTechnetium Sestamibi Single-Photon Emission Computerized Tomography | | VF | = ventricular fibrillation | | VT | = ventricular tachycardia |
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