Long-term outcomes in inferior ST-segment elevation myocardial infarction patients with right ventricular myocardial infarction

https://doi.org/10.1016/j.ijcard.2022.01.003Get rights and content

Highlights

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    RVMI did not increase all-cause mortality for patients with inferior STEMI in the contemporary reperfusion era;

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    RVMI increased all-cause mortality for inferior STEMI patients without reperfusion treatment;

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    Early recognition of RVMI and timely reperfusion may improve the prognosis of inferior STEMI patients with RVMI.

Abstract

Objective

To evaluate the prognostic influence of the presence of right ventricular myocardial infarction (RVMI) on patients with inferior ST-segment elevation myocardial infarction (STEMI) in the contemporary reperfusion era.

Methods

9308 patients with inferior STEMI were included from the prospective, nationwide, multicenter China Acute Myocardial Infarction Registry, including 1745 (18.75%) patients with RVMI and 7563 (81.25%) patients without RVMI. The primary outcome was two-year all-cause mortality. The secondary outcome was major adverse cardiac and cerebrovascular event (MACCE) defined as a composite of all-cause mortality, recurrent MI, revascularization, stroke, and major bleeding.

Results

After two-year follow up, there were no significant differences between inferior STEMI patients with or without RVMI in all-cause mortality (12.0% vs 11.3%; adjusted HR: 1.05; 95% CI: 0.90 to 1.24; P = 0.5103). Inferior STEMI with RVMI was associated with higher risk of MACCE (25.6% vs 22.0%; adjusted HR: 1.17; 95% CI: 1.05 to 1.31; P = 0.0038), revascularization (10.3% vs 8.1%; adjusted HR: 1.23; 95% CI: 1.03 to 1.48; P = 0.0218), and major bleeding (4.6% vs 2.7%; adjusted HR: 1.56; 95% CI: 1.18 to 2.07; P = 0.0019). Primary percutaneous coronary intervention (PCI) and thrombolysis were independent predictors to decrease all-cause mortality. For patients who received timely reperfusion, RVMI involvement did not increase all-cause mortality, whereas for those who did not undergo reperfusion, RVMI increased all-cause mortality (20.3% vs 15.7%; HR: 1.34; 95% CI: 1.10 to 1.63).

Conclusion

RVMI did not increase all-cause mortality for inferior STEMI patients in contemporary reperfusion era, whereas the risk was increased for patients with no reperfusion treatment.

Introduction

Right ventricular myocardial infarction (RVMI) occurs in approximately one-third to half of the patients with acute inferior MI, and may result in severe hemodynamic compromise [1]. Previous studies indicated that acute inferior MI with RVMI involvement appeared to have a worse prognosis with a mortality rate as high as 25% to 30%, as opposed to an overall mortality rate of approximately 6% of patients with acute inferior MI without RVMI involvement [2], [3]. However, these results were derived from the studies carried out before the primary percutaneous coronary intervention (PCI) era [3], [4], [5], [6]. With the recent improvement in reperfusion strategy, especially primary PCI techniques [7], [8], it is unclear whether the clinical outcomes in ST-segment elevation myocardial infarction (STEMI) patients with RVMI have changed and which factors may improve the outcomes of inferior STEMI patients with RVMI. Therefore, in this study, we sought to assess the prognostic significance of the presence of RVMI in patients with inferior STEMI and to explore factors associated with improved outcomes by using a large database representing real-world patients with STEMI.

Section snippets

Study population

The Chinese Acute Myocardial Infarction (CAMI) Registry is a prospective, nationwide, multicenter observational study of patients with AMI, which covers all the provinces and municipalities across mainland China and includes 31 provincial hospitals (university-affiliated academic hospitals located in the capital city of each province), 45 municipal hospitals (hospitals in medium-sized cities) in their own provinces or municipalities, and 32 county hospitals (hospitals in the smallest cities,

The number of included patients

A total of 26,648 patients with AMI were included in CAMI registry from January 2013 to September 2014. Of the 9308 patients with inferior STEMI but without acute anterior MI fulfilling our inclusion criteria, 1745 (18.75%) patients had RVMI while 7563 (81.25%) patients did not have RVMI (Supplementary Fig. S1).

The baseline characteristics of included patients

The baseline characteristics are recorded in Table 1. No significant differences were observed between inferior STEMI patients with or without RVMI in demographic characteristics and

Discussion

In the present analysis, we found that inferior STEMI patients with RVMI was associated with higher risks of sinus arrest/severe bradycardia, atrial-ventricular block, cardiogenic shock, MACCE, major bleeding, and revascularization as compared with those without RVMI, without significant differences in all-cause mortality. Moreover, primary PCI and thrombolysis were independent predictors to decrease both in-hospital and two-year all-cause mortality. For patients with no reperfusion, inferior

Conclusion

In summary, our results revealed that RVMI involvement was associated with higher risks of sinus arrest/severe bradycardia, atrial-ventricular block, cardiogenic shock, MACCE, major bleeding, and revascularization without significant difference in all-cause mortality for patients with inferior STEMI in the contemporary PCI era. In addition, for patients who received timely reperfusion, RVMI involvement did not increase all-cause mortality, whereas for those who did not undergo reperfusion

Declaration of Competing Interest

All authors declared no conflicts of interest.

Acknowledgements

This work was supported by the CAMS Innovation Fund for Medical Sciences (CIFMS) (2016-I2M-1-009) and the Twelfth Five-Year Planning Project of the Scientific and Technological Department of China (2011BAI11B02). We appreciate all the investigators and coordinators for their active participation and great contribution in data collection and patients enrollment.

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