Brief Article
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World J Cardiol. Jan 26, 2014; 6(1): 14-22
Published online Jan 26, 2014. doi: 10.4330/wjc.v6.i1.14
Primary reperfusion in acute right ventricular infarction: An observational study
Eulo Lupi-Herrera, Héctor González-Pacheco, Úrsulo Juárez-Herrera, Nilda Espinola-Zavaleta, Eduardo Chuquiure-Valenzuela, Ramón Villavicencio-Fernández, Marco Antonio Peña-Duque, Ernesto Ban-Hayashi, Sergio Férez-Santander
Eulo Lupi-Herrera, The American British Cowdray Medical Center I.A.P., Mexico City 14080, Mexico
Sergio Férez-Santander, Subdivisions of Clinical-Research and Teaching, National Institute of Cardiology Ignacio Chavez, Mexico City 14080, Mexico
Héctor González-Pacheco, Úrsulo Juárez-Herrera, Eduardo Chuquiure-Valenzuela, Coronary Care Unit, National Institute of Cardiology Ignacio Chavez, Mexico City 14080, Mexico
Nilda Espinola-Zavaleta, Ramón Villavicencio-Fernández, Marco Antonio Peña-Duque, Ernesto Ban-Hayashi, Echocardiography and Interventional Cardiology Departments, National Institute of Cardiology Ignacio Chavez, Mexico City 14080, Mexico
Author contributions: Lupi-Herrera E designed, performed the research, analyzed the obtained data and wrote the manuscript; González-Pacheco H, Juárez-Herrera Ú, Chuquiure-Valenzuela E performed the research, wrote the manuscript and analyzed the obtained data; Villavicencio-Fernández R, Peña-Duque MA, and Ban-Hayashi E performed the cardiac catheterization studies and primary percutaneous coronary intervention; Espinola-Zavaleta N analyzed the echocardiographic studies, provided new reagents and also were involved in writing and editing the manuscript; Férez-Santander S was involved in editing the manuscript.
Correspondence to: Eulo Lupi-Herrera, MD, FACC, Director of the Cardiovascular Division, The American British Cowdray Medical Center I.A.P., Sur 136-116, Col Las Américas, Mexico City 14080, Mexico. elupih@abchospital.com
Telephone: +52-33-308000 Fax: +52-33-308000
Received: July 3, 2013
Revised: September 11, 2013
Accepted: December 12, 2013
Published online: January 26, 2014
Processing time: 207 Days and 16.5 Hours
Abstract

AIM: To investigate the impact of primary reperfusion therapy (RT) on early and late mortality in acute right ventricular infarction (RVI).

METHODS: RVI patients (n = 679) were prospectively classified as without right ventricular failure (RVF) (class A, n = 425, 64%), with RVF (class B, n = 158, 24%) or with cardiogenic shock (CS) (class C, n = 96, 12%). Of the 679 patients, 148 (21.7%) were considered to be eligible for thrombolytic therapy (TT) and 351 (51.6%) for primary percutaneous coronary intervention (PPCI). TIMI 3-flow by TT was achieved for A, B and C RVI class in 65%, 64% and 0%, respectively and with PPCI in 93%, 91% and 87%, respectively.

RESULTS: For class A without RT, the mortality rate was 7.9%, with TT was reduced to 4.4% (P < 0.01) and with PPCI to 3.2% (P < 0.01). Considering TT vs PPCI, PPCI was superior (P < 0.05). For class B without RT the mortality was 27%, decreased to 13% with TT (P < 0.01) and to 8.3% with PPCI (P < 0.01). In a TT and PPCI comparison, PPCI was superior (P < 0.01). For class C without RT the in-hospital mortality was 80%, with TT was 100% and with PPCI, the rate decreased to 44% (P < 0.01). At 8 years, the mortality rate without RT for class A was 32%, for class B was 48% and for class C was 85%. When PPCI was successful, the long-term mortality was lower than previously reported for the 3 RVI classes (A: 21%, B: 38%, C: 70%; P < 0.001).

CONCLUSION: PPCI is superior to TT and reduces short/long-term mortality for all RVI categories. RVI CS patients should be encouraged to undergo PPCI at a specialized center.

Keywords: Right ventricular infarction; Reperfusion therapy; Ventricular failure; Cardiogenic shock; Morbidity; Mortality

Core tip: It is, up to our knowledge the largest series of acute right ventricular infarction (RVI) patients where all the clinical RVI spectrum is considered. RVI is analyzed in relation to primary reperfusion procedures, over a study period with a more widespread use of primary percutaneous coronary intervention (PPCI) together with the advent of stents and antiplatelet agents to provide a better insight into reperfusion trends and results in acute RVI. According to our findings, in all RVI hemodynamic scenario PPCI is superior to thrombolytic therapy (TT) and reduces short and long-term mortality for all 3 RVI categories. Patients in cardiogenic shock should be encouraged to undergo PPCI rather than TT at a specialized center.