RVI represents an easily detectable, highly prevalent subset of acute inferior
infarction associated with poor outcome even in the era of thrombolysis. Primary PTCA may offer advantages in patients with inferior
infarction involving the right ventricle.
METHODS: Primary coronary angioplasty with optimal stenting was performed in 87 of 88 consecutive patients presenting within 24 hours after onset of
acute inferior myocardial infarction. On the basis of right precordial ST segment elevations at admission, patients were classified into those without (n=61) and those with RVI (n=27). The patients were followed prospectively for angiographic success
at 10 days and for in-hospital clinical outcome.
RESULTS: Baseline characteristics including age, severity of
coronary artery disease, proportion of
stent implantation, and occurrence of
cardiogenic shock were comparable. Patients with RVI had larger
infarct sizes (
lactate dehydrogenase level: 962 vs 580 U/l, P=0.03), developed more often complete
atrioventricular block (18.5 vs. 2%, p=0.0038), needed more often
parasympatholytics (48.1 vs 18.8%, p<0.001), and had a substantially higher incidence of the Bezold-Jarisch reflex (29.6 vs 6.6%, p<0.01) following reperfusion. Success of recanalization
therapy acutely and
at 10 days, as well as in hospital mortality were similar in patients with and without RVI (88.5 vs. 85.2%, 79.3 vs. 84.7%, 7.4 vs 9.8%). However, patients with RVI revealed a greater lumen gain acutely after PTCA (2.49 vs. 2.13 mm, p=0.025) and experienced less frequently major
cardiac events (14.8 vs. 36.1%, p=0.04) which included reinfarction, re-
ischemia, coronary bypass grafting,
stent thrombosis, and
cardiac death. In addition, procedural success was established more rapidly (fluoroscopy time: 10 vs 15 min., p=0.032) and with less
contrast material (242 vs 295 ml, p=0.015) in patients with RVI. This is probably due to the more proximal location (84.6 vs 6.6%, p<0.0001) and the larger reference diameter (3.17 vs. 2.79 mm, p=0.03) of the occluded right coronary artery.
CONCLUSIONS: