ACUTE RIGHT-VENTRICULAR MYOCARDIAL-INFARC TION - NEW APPROACHES TO THE DIAGNOSIS AND TREATMENT OF A DISEASE WITH A POOR-PROGNOSIS

Background: Acute inferior myocardial infarction frequently involves t he right ventricle (RV). However, very little is known on the prognost ic impact of RV involvement in the in-hospital and longterm course, as well as on reliable diagnostic strategies to identify RV infarction e arly after admission. Patients and methods: In 200 consecutive patient s with acute inferior myocardial infarction, we assessed on admission the prevalence and diagnostic accurracy of ST elevation in lead V4R to determine RV involvement, as well as its prognostic implications for in-hospital complications, early and late mortality and the benefit of thrombolytic therapy. Follow-up period was one to six years (mean +/- SD, 37 +/- 12 months). Results: In-hospital mortality after inferior myocardial infarction was 19%, major complications occurred in 47% of patients. Presence of ST-segment elevation in V4R in 107 patients (54% ) was highly predictive of RV infarction (sensitivity: 88%, specificit y: 78%, diagnostic efficiency: 83%) and increased the in-hospital mort ality rate from 6% to 31% (p < 0.0001) and major in-hospital complicat ions from 28% to 64% (p < 0.0001). Cox regression analysis showed ST e levation in V4R to be independent of and superior to all other clinica l variables available at the time of admission (additional risk for in -hospital mortality: 7.7; for major complications: 4.7). Thrombolysis was associated with a reduced mortality (3.7 times, p < 0.0005) and co mplication rate (2.4 times, p < 0.0001) only in patients with PV infar ction. Post-hospital course was similar in patients with and without R V infarction. Conclusions: RV involvement during acute inferior myocar dial infarction, accurately diagnosed by ST-segment elevation in VR, i s a strong, independent parameter for mortality and major in-hospital complications and may help to identify patients who will benefit most from thrombolytic therapy. Electrocardiographic assessment of RV infar ction should be routinely performed in all patients admitted with acut e inferior myocardial infarction.