RAPID HEMODYNAMIC IMPROVEMENT AFTER REPERFUSION DURING RIGHT-VENTRICULAR INFARCTION

Objectives. This study sought to determine the effects of reperfusion on hemodynamic status and hospital course in patients with right ventr icular infarction. Background. In contrast to the relatively low risk associated with acute inferior myocardial infarction, right ventricula r infarction is associated with higher in hospital morbidity and morta lity. However, the potential benefits of reperfusion in patients with right ventricular infarction are unknown. Consequently, this study eva luated the potential benefits of primary angioplasty in patients,vith right ventricular infarction. Methods. Of 131 consecutive patients adm itted to the hospital for inferior myocardial infarction, 27 were iden tified as having right ventricular involvement by electrocardiographic and hemodynamic criteria. Seventeen patients achieved patency of the infarct-related right coronary artery by primary coronary angioplasty within 24 h of hospital admission, but 10 patients did not. All patien ts had invasive hemodynamic monitoring at the time of hospital admissi on, and subsequent serial hemodynamic status and clinical events were recorded. Results. Patients with successful reperfusion demonstrated i mproved right atrial pressure, pulmonary capillary,wedge pressure and right atrial/pulmonary capillary wedge pressure ratio as early as 8 h after reperfusion, whereas patients without reperfusion had no hemodyn amic improvement over 24 h. Right atrial pressure demonstrated the gre atest 8 h improvement after successful reperfusion (15.4 +/- 0.8 to 8. 4 +/- 0.8 mm Hg [mean +/- SD], p < 0.05) but was unchanged without rep erfusion (13.7 +/- 0.9 to 13.9 +/- 0.8 mm Hg, p = NS). Additionally, p ersistently elevated right atrial pressure was associated with increas ed mortality. Conclusions. Reperfusion in the setting of right ventric ular infarction leads to rapid hemodynamic improvement and may result in improved survival.