Background: Previously published reports regarding adverse effect of right ventricular infarction (RVI) have been based on the various therapeutic backgrounds with or without revascularization. Primary percutaneous coronary intervention (PCI) has been currently the common therapeutic procedure for acute coronary syndrome, which has been contributing to the better clinical outcome after acute myocardial infarction.
Purpose: We aimed to update the clinical impact of RVI in the era of primary PCI with its incidence, hemodynamics and short-term/ long-term outcomes after successful emergency revascularization.
Methods: Consecutive 1,016 patients with acute coronary syndrome who were carried into our cardiovascular center (March 2011-April 2014) were retrospectively examined. In these patients, 167 patients with first-onset acute inferior MI who underwent successful primary PCI were recruited. All the patients were continuously monitored by Swan-Ganz catheter in the coronary care unit.
Results: 30 (18.0%) patients were diagnosed as hemodynamically significant RVI. Cardiogenic shock on arrival was more frequently seen in the RVI group than the no-RVI group (9 (30.0%) vs. 5 (3.6%), p<0.001) and the RVI group required intra-aortic balloon pumping to stabilize hemodynamic status more frequently than the no-RVI group (9 (30.0%) vs. 7 (5.1%), p<0.001). In the majority of RVI patients, hemodynamic parameters rapidly improved after primary PCI followed by intensive medical treatment under the careful monitoring by Swan-Ganz catheter. Nevertheless, the course of hemodynamic condition varied in each individual and RVI on admission was associated with adverse in-hospital (30-day) and long-term (3-year) prognosis (Figures).
RVI: Hemodynamics and prognostic impact
Conclusions: RVI is still critical in the modern PCI era. RVI worsened short-term and long-term prognosis, and careful intensive care should be needed even after successful revascularization.
