State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100037, China.
The First People's Hospital of Tianmen, Tianmen 431700, China.
Int J Cardiol. 2022 Mar 15;351:1-7. doi: 10.1016/j.ijcard.2022.01.003. Epub 2022 Jan 5.
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.
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.
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).
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.
评估右心室心肌梗死（RVMI）对当代再灌注时代下下壁 ST 段抬高型心肌梗死（STEMI）患者预后的影响。
9308 例下壁 STEMI 患者纳入前瞻性、全国性、多中心的中国急性心肌梗死注册研究，其中 1745 例（18.75%）患者合并 RVMI，7563 例（81.25%）患者未合并 RVMI。主要结局为 2 年全因死亡率。次要结局为主要不良心脑血管事件（MACCE），定义为全因死亡率、再发心肌梗死、血运重建、卒中和大出血的复合终点。
2 年随访后，下壁 STEMI 患者无论是否合并 RVMI，全因死亡率均无显著差异（12.0% vs. 11.3%；调整 HR：1.05；95%CI：0.90 至 1.24；P=0.5103）。合并 RVMI 的下壁 STEMI 患者 MACCE 风险更高（25.6% vs. 22.0%；调整 HR：1.17；95%CI：1.05 至 1.31；P=0.0038）、血运重建（10.3% vs. 8.1%；调整 HR：1.23；95%CI：1.03 至 1.48；P=0.0218）和大出血（4.6% vs. 2.7%；调整 HR：1.56；95%CI：1.18 至 2.07；P=0.0019）的风险更高。直接经皮冠状动脉介入治疗（PCI）和溶栓是降低全因死亡率的独立预测因素。对于接受及时再灌注的患者，RVMI 并不增加全因死亡率，而对于未接受再灌注治疗的患者，RVMI 会增加全因死亡率（20.3% vs. 15.7%；HR：1.34；95%CI：1.10 至 1.63）。
在当代再灌注时代，RVMI 并未增加下壁 STEMI 患者的全因死亡率，而对于未接受再灌注治疗的患者，其风险增加。
