Primary reperfusion in acute right ventricular infarction: An observational study

• Published in: World journal of cardiology Vol. 6; no. 1; pp. 14 - 22
• Main Author: Eulo Lupi-Herrera Héctor González-Pacheco úrsulo Juárez-Herrera Nilda Espinola-Zavaleta Eduardo Chuquiure-Valenzuela Ramón Villavicencio-Fernández Marco Antonio Pea-Duque Ernesto Ban-Hayashi Sergio Férez-Santander
• Format: Journal Article
• Language: English
• Published: United States Baishideng Publishing Group Co., Limited 26.01.2014
• Subjects: Brief; Cardiogenic; failure; infarction; Morbidity; Mortality; Reperfusion; Right; shock; therapy; ventricular; Right ventricular infarction; Reperfusion therapy; Ventricular failure; Cardiogenic shock; Mortality; Morbidity
• ISSN: 1949-8462; 1949-8462
• DOI: 10.4330/wjc.v6.i1.14

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.