Comparison of In-Hospital Mortality between Acute Inferior Wall STEMI Patients with and without Right Ventricular Infarction Undergoing Primary PCI
Sumet Preechawuttidej¹, Wacin Buddhari², Jarkarpun Chaipromprasit², Vorarit Lertsuwunseri², Siriporn Athisakul², Chaisiri Wanlapakorn², Suphot Srimahachota²
Affiliation : ¹ Department of Medicine, Taksin Hospital, Bangkok, Thailand, ² Cardiac Center and Division of Cardiology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
Background: Patients with acute inferior wall ST elevation myocardial infarction (STEMI) with right ventricular infarction (RVI) involvement have a worse prognosis. However, most patients in the previous studies were treated with intravenous fibrinolysis and they were in the Caucasian populations.
Objective: To compare the in-hospital mortality rate of patients with acute inferior wall STEMI with and without RVI treated with primary percutaneous coronary intervention (PPCI).
Materials and Methods: The present study was a retrospective descriptive study that enrolled patients with acute inferior wall STEMI treated with PPCI in King Chulalongkorn Memorial Hospital between January 1, 2007, and December 31, 2016.
Results: Among 452 acute inferior wall STEMI patients treated with PPCI, 99 patients had RVI. The in-hospital mortality rate was 23.2% compared with 5.1% in patients without RVI (p<0.001). Patients with RVI had a significantly higher incidence of cardiogenic shock at 48.5% versus 15.6% (p<0.001), lower left ventricle ejection fraction at 51.15±17.27% versus 55.79±12.46% (p=0.037), higher incidence of complete heart block at 33.3% versus 11.9% (p<0.001), and ventricular tachycardia at 15.2% versus 5.9% (p=0.003). After adjustment for age, female gender, cardiogenic shock on admission, left ventricular ejection fraction (LVEF), ventricular tachycardia, and complete heart block, the RVI had a tendency to be the poor predictor for in-hospital death (adjusted HR 1.96; 95% CI 0.73 to 5.23; p=0.18). Nevertheless, the RVI was the significant independent predictor for 1-year mortality (adjusted HR 2.12; 95% CI 1.03 to 4.36; p=0.041).
Conclusion: Patients with acute inferior wall STEMI and RVI treated with PPCI had higher in-hospital mortality compared to no RVI. The RVI tended to have worse outcomes than those without RVI.
Received 22 November 2021 | Revised 1 June 2022 | Accepted 13 June 2022
DOI: 10.35755/jmedassocthai.2022.08.13446
Keywords : Acute inferior wall STEMI; Right ventricular infarction; Mortality
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