THROMBOLYTIC THERAPY IN RIGHT-VENTRICULAR INFARCTION

Right ventricular (RV) involvement during acute inferior myocardial in farction is common and considered to be of prognostic relevance. It wa s speculated that particularly those patients with RV involvement woul d profit most from the use of thrombolytic therapy and thus are the ke y patient group to understanding controversial results on the overall clinical benefit of using thrombolysis during acute inferior myocardia l infarction. In 200 consecutive patients with acute inferior myocardi al infarction we assessed the eligibility for thrombolytic therapy and the prognostic impact of RV infarction in patients eligible or non-el igible for reperfusion therapy. Prognostic analyses were based on the in-hospital period and a 1-6-year follow-up (mean: 36 +/- 11 months). When based on ST-segment elevation in V4R, known as a reliable predict or for RV infarction (sensitivity 88%; specificity 78%; diagnostic eff iciency 83%), 107 patients (54%) presented with evidence of RV ischemi a. Seventy-one patients (36%) were found eligible for thrombolytic the rapy. These patients showed a lower mortality (6/71 patients, 8%) and complication rate (22/71 patients, 31%) compared to patients non-eligi ble for thrombolysis (mortality: 32/129 patients, 25%; P<0.001; major complications: 72/129 patients, 56%; P<0.01). Benefit of thrombolytic therapy, however, was only recognized in patients with RV infarction c omplicating acute inferior myocardial infarction (mortality: 10% vs 42 %, P<0.005; complication rate: 34% vs 54%, P<0.01). Without this compl ication, there was no difference in mortality (7% vs 6%, ns) or in maj or in-hospital complications (27% vs 29%, ns), whether the patient was found eligible or non-eligible for thrombolytic therapy. Post-hospita l course over 36 +/- 11 months was not different in patients with and without RV infarction, but best in all patients considered for reperfu sion therapy. RV infarction is a common complication of acute inferior myocardial infarction, determines an unfavourable in-hospital prognos is and identifies patients who will profit most from using thrombolyti c therapy.