Prognostic significance of right ventricular infarction diagnosed by ST elevation in right chest leads V3R to V7R.

The prognostic significance of electrocardiographic "extensive right ventricular infarction" diagnosed by ST elevation greater than or equal to 1 mm in right chest leads V3R to V7R during inferior/posterior infarction was evaluated in 158 consecutive patients with first anterior (n = 72) or inferior/posterior (n = 86) myocardial infarction. At follow-up the maximum observation time was 3.0 years (mean 1.8 years). A total of 49 patients died; 96% due to cardiac causes. Twelve patients (8%) died during the first 24 hours of admission. Ten-day mortality was 18% (n = 29). Using Cox multivariate analysis ST elevation in right chest leads during inferior/posterior infarction was an independent predictor of prognosis in patients surviving the initial 10 days after infarction (n = 129). For these patients the cumulative survival was better after inferior/posterior infarction with ST elevation in V3R to V7R (n = 25) compared with (1) inferior/posterior infarction without St elevation in these leads (n = 45, P = 0.09), (2) anterior infarction (n = 59, P = 0.08), and (3) all other infarctions (n = 104, P = 0.05). Infarct size estimated by the peak serum enzyme values was similar in these groups. Thus, electrocardiographic extensive right ventricular infarction predicts a good prognosis in patients alive 10 days after infarction. Compared with infarcts of similar size but with another location the prognosis is better, probably due to concomitant smaller left ventricular infarction with better left ventricular function following infarction.