Infarction with right ventricular compromise and relationship with hospital outcome

Abstract

Introduction:acute myocardial infarction (AMI) with right ventricular (RV) compromise is a challenge in patients’ management.Objectives: to evaluate clinical characteristics and hospital evolution of patients (pts) with ST-elevation myocardial infarction (STEMI) and RV compromise hospitalized at the Institute of Cardiology of the City of Corrientes.Material and methods: prospective,observational registry,1,126 consecutive patients with STEMI,admitted from 01-01-2017 to 12-31-2022.Anterior AMI was present in 51.9%, 9.6% presented RV compromise.The population was separated into 2 Groups: I)with and II)without RV compromise.Results: the mean age was 64.9vs62.8 ± 12 years (p=0.10), diabetes 31.5vs39.7 (p=0.63). Mean blood glucose 188.2 vs 167.8 mg/d (p=0.042),hs-TnT 4659 vs 2822 ng/dl (p=0.003).In-hospital mortality in both groups was 15.4 vs 5.1% (p<0.001),reinfarction 8.1 vs 4.6% (p=0.048),atrial fibrillation 16.8 vs 9.1% (p=0.004),3rd degree AV block (AVB), 13.4 vs 2.3% (p=<0.001) Swan Gans was applied in 18.1 vs 5.5% (p=0001);mechanical respiratory assistance in 13.4 vs 7.9 % (p=0.020), angiography 95.2 vs 96.9% (p=0.28),thrombolytic therapy 5.4 vs 5.2% (p=0.92) and primary angioplasty 75 vs 76.1% (p=0.32).Multivariate analysis showed predictors of mortality:age OR (1.062 95% CI 1.031-1.094, p=0.001),Killip ≥2 OR=2.1 (95% CI 1.88-4.73, p=0.004),creatinine OR=1.55 (95% CI 1.10-2.18 p=0.015), and RV OR=2.82 (95% CI 1.17-5.6, p=0.003). The risk of RV compromise, anterior ST depression and complete AVB was analyzed; with RV compromise,mortality was 15.4%, with 2 factors 20.5% and with 3 it increased to 28.2%.Conclusions: RV compromise triples in-hospital mortality, it has a worst outcome and was dependent on mortality, which was greater with RV compromise, complete AV block and anterior ST depression.