Assali Abid R, Teplitsky Igal, Ben-Dor Itsik, Solodky Alejandro, Brosh David, Battler Alexander, Fuchs Shmuel, Kornowski Ran
Cardiology Department, The Cardiac Catheterization Laboratories, Rabin Medical Center, Petah Tikva, affiliated to the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
Am Heart J. 2007 Feb;153(2):231-7. doi: 10.1016/j.ahj.2006.10.038.
Right ventricular (RV) involvement during acute inferior myocardial infarction (MI) is associated with increased early morbidity and mortality. With recent improvement in percutaneous coronary intervention (PCI) techniques, it is unclear which factors may improve the outcomes of these patients. We sought to assess the prognostic significance of the presence of right ventricular myocardial infarction (RV-MI) in patients undergoing primary PCI and to explore factors associated with improved outcomes by using a large database representing the "real life" of patients with acute MI (AMI) treated by primary PCI.
We analyzed our database of patients with AMI undergoing primary PCI within 12 hours of chest pain between January 2001 and June 2005, excluding patients with cardiogenic shock.
Of the 666 consecutive patients with MI fulfilling our inclusion criteria, 329 had anterior wall MI, 264 had inferior (230 inferior + 34 lateral) wall MI, and 73 had RV-MI. Mortality at hospital discharge, 30 days, and 6 months was highest in patients with RV-MI involvement (5.5%, 9.6%, and 12.3%, respectively), intermediate in patients with anterior MI (2.4%, 4.6%, and 7.3%, respectively), and lowest in patients without RV myocardial involvement (0.8%, 1.1%, and 3%, respectively) (P < .05 for hospital discharge and 30 days, P = .1 for 6 months). After adjustment for the CADILLAC score, odds ratio for 30-day morbidity was 5.2 (95% CI 1.6-17, P = .005) for patients with RV-MI versus those without RV-MI. Within the group of patients with RV-MI, complete revascularization of the right coronary artery including the major RV branch was associated with higher rate of RV function recovery by echocardiography and improved 30-day mortality (odds ratio 0.4, 95% CI 0.1-1.05, P = .06).
Right ventricular infarction is an independent risk factor for increased mortality even in these days of primary PCI. Intensive medical therapy including restoring blood flow into the right coronary artery including the major RV branch may improve clinical outcomes.
急性下壁心肌梗死（MI）期间右心室（RV）受累与早期发病率和死亡率增加相关。随着经皮冠状动脉介入治疗（PCI）技术的近期改进，尚不清楚哪些因素可改善这些患者的预后。我们试图评估接受直接PCI的患者中右心室心肌梗死（RV-MI）存在的预后意义，并通过使用代表接受直接PCI治疗的急性心肌梗死（AMI）患者“真实生活”的大型数据库来探索与改善预后相关的因素。
我们分析了2001年1月至2005年6月期间在胸痛12小时内接受直接PCI的AMI患者数据库，排除心源性休克患者。
在符合我们纳入标准的666例连续MI患者中，329例为前壁MI，264例为下壁（230例下壁+34例侧壁）MI，73例为RV-MI。RV-MI受累患者的出院时、30天和6个月死亡率最高（分别为5.5%、9.6%和12.3%），前壁MI患者居中（分别为2.4%、4.6%和7.3%），无RV心肌受累患者最低（分别为0.8%、1.1%和3%）（出院时和30天P<.05，6个月P=.1）。调整CADILLAC评分后，RV-MI患者与无RV-MI患者相比，30天发病率的比值比为5.2（95%CI 1.6-17，P=.005）。在RV-MI患者组中，包括主要RV分支在内的右冠状动脉完全血运重建与超声心动图显示的RV功能恢复率较高和30天死亡率改善相关（比值比0.4，95%CI 0.1-1.05，P=.06）。
即使在直接PCI时代，右心室梗死仍是死亡率增加的独立危险因素。包括恢复流入包括主要RV分支在内的右冠状动脉的血流在内的强化药物治疗可能改善临床结局。
