Primary reperfusion in acute right ventricular infarction: An observational study

doi:10.4330/wjc.v6.i1.14

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World Journal of Cardiology

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1949-8462

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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

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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

Table 1 Clinical characteristics of the 679 patients separated according to right ventricular infarction class

Variables	Class A	Class B	Class C
	n = 425	n = 158	n = 96
	(64%)	(24%)	(12%)
Age (yr)	59.7 ± 9.4	61 ± 10	62.4 ± 8.4
Age 64-74 yr	41.9%	38.7%	37.5%
Men	82%	81%	83%
Pre-IA	38%	40%	41%
Peak CK IU/L median (25^th-75^th percentiles)	1854 (1654-2490)	1994 (1214-2634)	2109 (1532-2812)
Peak MB fraction IU/L median (25^th-75^th percentiles)	188 (111-350)	201 (126-312)	192 (104-333)
Diabetes	26.9%	27.8%	30.6%
Hypertension	40.7%	44.3%	44.4%
Hypercholesterolemia	23%	19%	21%
Smoking	58%	60%	55%
BMI (kg/m²)	28.2 ± 4.4	26.7 ± 5.2	27.2 ± 3.9

No statistically significant differences between right ventricular infarction classes were found. Pre-IA: Infarction angina; CK: Creatine kinase; BMI: Body mass index; MB: Myocardial B.

Table 2 Echocardiographic data at baseline according to right ventricular infarction class

Variable	Class A	Class B	Class C	Total
Variable	(n = 396)	(n = 152)	(n = 94)	(n = 642)
RV-dilatation	0%	100%^b	100%	38.3%
VWMA	100%	100%	100%	100%
WMA only for IW	84%	0%	0%	51.7%
WMA for IW + OW	16%	100%^b	100%	48%
TR	17%	100%^b	100%	48%
AVSM	25%	78%^b	70%	43.9%
RVMI	1.9% ± 0.3%	2.5% ± 0.2%^b	3.4% ± 0.5%^d	2.4% ± 4%
RVD/LVD > 1	0%	25%^b	83%^d	18%
RVD/LVD = 1	0%	65%^b	17%^d	18%
ARAWM	0%	18%^b	25%	8%
RA-DPS n (%)	0 (0)	19 (70)	10 (43)^d	29 (58)
LVEF < 0.5	11%	22%	34%^d	16%

Echocardiographic data at baseline according to right ventricular infarction class (n = 642/679, 94.5%); transthoracic (TT): 375 (58%), transesophageal (TE): 267 (42%).

^bP < 0.01 vs classes A;

^dP < 0.01 vs classes B. RV: Right ventricle; VWMA: Ventricular wall motion abnormalities; IW: Inferior wall for LV + RV; OW: Other walls; TR: Tricuspid regurgitation; AVSM: Abnormal ventricular septal motion; RVMI: Right ventricular motion index (mean ± SD); RVD/LVD: Diastolic ratio of the two ventricles; ARAWM: Abnormal right atrial wall movements; RA-DPS: Right atrium dobutamine positive stress; LVEF: Left ventricular ejection fraction.

Table 3 Hemodynamic data at baseline according to the right ventricular infarction class

Variable	Class A	Class B	Class C
Variable	(n = 350)	(n = 158)	(n = 96)
mRAP (mmHg)	4.6 ± 2.1	12.9 ± 3.6^b	21.4 ± 5.15^d
REVDP (mmHg)	3.4 ± 1.7	11.2 ± 4^b	16 ± 5.4^d
sPAP (mmHg)	16.2 ± 4.4	16.4 ± 3.9	36.8 ± 9.3^d
dPAP (mmHg)	9.7 ± 3.7	13.4 ± 2.2	22.2 ± 3.9^d
mPWP (mmHg)	8.6 ± 3.1	12.1 ± 1.8	19.9 ± 6.2^d
CI (L.min/m²)	3.4 ± 0.71	2.4 ± 0.21^b	1.67 ± 0.5^d
mSAP (mmHg)	108.8 ± 7	78.7 ± 12.3^b	62.7 ± 9.5^d
RAP/PWP ≥ 0.8	2%	96%^b	92%

Hemodynamic data at baseline according to the right ventricular infarction class (n = 604, 89%).

^bP < 0.01 vs classes A;

^dP < 0.01 vs classes B. m: Mean; s: Systolic; d: Diastolic; RAP: Right atrial pressure; RVEDP: Right ventricular end diastolic pressure; PAP: Pulmonary artery pressure; PWP: Pulmonary wedge pressure; CI: Cardiac index; SAP: Systemic arterial pressure.

Table 4 Coronary angiographic data at baseline according to the right ventricular infarction class n (%)

Variable	Class A	Class B	Class C	Total
Variable	(n = 425)	(n = 158)	(n = 96)	Total
Angiography	291 (68)	123 (77)	85 (88)	499 (73)
PCI	213	93	76	382 (76.5)
TT	78	30	9	117 (23.4)
RCA culprit vessel	266 (91)	123 (100)	85 (100)	474 (95)
RCA CL-location
Proximal	42 (16)	85 (69)^b	78 (92)^d	205 (43)
Mid	144 (54)	26 (21)^b	6 (7)^d	176 (37)
Distal	80 (30)	12 (9)^b	1 (1)^d	93 (19)
1-VD	144 (54)	39 (32)^b	11 (14)	194 (40.9)
2-VD	96 (36)	31 (25)	32 (37)	159 (33.5)
3-VD	26 (9)	53 (43)^b	42 (49)	121 (25.5)
RCA + LAD-D	29 (11)	44 (36)^b	45 (53)^d	118 (24.8)
100% RCA-O	119 (45)	68 (55)	53 (62)	240 (48)
Without CCC	47 (40)	36 (53)	47 (89)^d	130 (54)
With CCC	72 (60)	32 (47)	6 (11)^d	110 (45)
Grade 1	9	10	0	19
Grade 2	36	12	0	48
Grade 3	27	10	6	43
RCA–RVB-RAB flow
TIMI grade flow	0.8 ± 1.4	0.7 ± 1	0.6 ± 0.7	0.7 ± 1
TIMI 3 flow in all RVB	194 (72)	0 (0)^b	0 (0)	194 (40)
Impaired flow in 1 RVB	56 (21)	11 (8.9)^b	0 (0)	67 (14)
Impaired flow in ≥ 2
RVB	16 (6)	41 (33)^b	6 (7)^d	63 (13)
No flow in all RVB	0 (0)	71 (57)^b	79 (92)^d	150 (31)
RAB with no flow	0 (0)	19 (15)^b	29 (34)^d	48 (10)

Coronary angiographic data at baseline according to the right ventricular infarction class (n = 499/679, 73%).

^bP < 0.01 vs classes A;

^dP < 0.01 vs classes B; TIMI: Thrombolysis in myocardial infarction. V: Vessel; D: Disease; O: Obstruction; RCA: Right coronary artery; CL: Culprit lesion; CCC: Coronary collateral circulation; RVB: Right ventricular branch; RAB: Right atrial branch; PCI: Primary coronary intervention; LAD-D: Left anterior descending diseases; TT: Transthoracic.

Table 5 Procedural variables and results of primary reperfusion at entry according to right ventricular infarction class (n = 679)

Variable	Class A	Class B	Class C	Total
Variable	(n = 425)	(n = 158)	(n = 96)	Total
Symptoms to admission time (min-max) h	4.6 (2-23)	5.5 (3.4-19)	27 (19-48)^d
Medical treatment	111 (26)	44 (27)	25 (26)	180 (26.5)
TT	109 (25)	30 (19)^b	9 (9)^d	148 (21.7)
Primary PCI	205 (48)	84 (53)	62 (64)	351 (51.6)
Stent use	182 (88)	80 (95)	62 (100)	324 (92)
IIb/IIIa GI use	49%	47%	52%
Inotropes/vasopressors	0%	100%^b	100%
Temporary pacemaker	1.20%	10.7%^b	29%^d
IABP support	0	0	73.9%^d
MVA	0	0	100%^d
Median time from MI to reperfusion treatment (min-max) h	1.9 (1.3-4)	2.1 (1.4-3.8)	14 (8-22)^d
Door-to-needle time (min)	42 ± 18	48 ± 16	-
Door-to-balloon time (min)	93 ± 24	89 ± 37	198 ± 102^d
TIMI 3 flow after PCI	93%	91%	87%
TIMI 3 flow after TT	65%	64%	0%^d
RCA-Extensive clot burden	17%	22%	75%^d
At 24-48 h reversal of RVWMA with SR	84%	78%	69%^d

^bP < 0.01 vs classes A;

^dP < 0.01 vs classes B. TT: Transthoracic; PCI: Primary coronary intervention; IABP: Intra-aortic balloon pump; MVA: Mechanical ventilatory assistance; RCA: Right coronary artery; SR: Success reperfusion; RVWMA: Right ventricular wall motion abnormalities; GI: Glucoprotein inhibitors; MI: Myocardial infarction; TIMI: Thrombolysis in myocardial infarction.

Table 6 Hospital outcomes based on reperfusion for each RVI class n (%)

Variable	Class A				Class B				Class C
	NR	TT	PCI	Total	NR	TT	PCI	Total	NR	TT	PCI	Total
	(n = 111)	(n = 109)	(n = 205)	(n = 425)	(n = 44)	(n = 30)	(n = 84)	(n = 158)	(n = 25)	(n = 9)	(n = 62)	(n = 96)
AVB+	16 (14)	7 (6)^b	11 (5)	34 (8)	14 (31)	9 (30)	6 (7)^d	29 (18)^h	22 (88)	8 (88)	13 (20)	43 (45)^f
SVT/VF+	18 (16)	6 (5)^b	9 (4)	33 (8)	18 (40)	9 (30)	4 (4.7)^d	31(19.6)^h	14 (56)	5 (55)	9 (14)^d	28 (29)^f
AF/PAT	4 (3)	3 (2.7)	0 (0)	7 (1.6)	5 (11)	6 (20)	4 (4.7)^d	15 (9.4)^h	4 (16)	2 (22)	5 (8)	11 (11)
R-MI+	6 (5)	8 (7.3)	2 (0.9)	16 (4)	4 (9)	3 (10)	1 (1)	8 (5)	2 (8)	2 (22)	3 (4.8)	7 (7.2)
UTVR+	6 (5)	4 (3.6)	2 (0.9)	12 (3)	3 (6)	1 (3)	1 (1)	5 (3)	2 (8)	1 (11)	3 (4.8)	6 (6)
MR/T+	0 (0)	2 (1.8)	0 (0)	2 (0.4)	4 (9)	2 (6)	0 (0)	6 (3.7)	4 (16)	2 (22)	2 (3)	8 (8.3)
ARF	4 (3)	3 (2.7)	2 (0.9)	9 (2)	4 (9)	2 (6)	4 (4.7)	10 (6)	5 (20)	3 (33)	10 (16)	18 (19)
SSH+	18 (16)	2 (1)^b	0 (0)	20 (5)	-	-	-	-	-	-	-	-
E-CS+	8 (7)	6 (5)	0 (0)	14 (3.2)	10 (22)	4 (13)^b	8 (9)	22 (14)^h	-	-	-	-
Death	9 (7.9)	5 (4.4)^a	5 (3.2)^f	19 (4.4)	12 (27)	4 (13)^b	7 (8.3)^d	23 (14.5)^h	20 (80)	9 (100)	27 (44)^d	56 (58)^f

^aP < 0.05,

^bP < 0.01 vs NR;

^dP < 0.01 vs primary coronary intervention (PCI);

^fP < 0.01 vs classe B;

^hP < 0.01 vs classe C. NR: Not send to reperfusion; TT: Transthoracic; AVB: Atrio-ventricular block requiring pacing; SVT: Sustained ventricular tachycardia; VF: Ventricular fibrillation; AF: Atrial fibrillation; PAT: Paroxysmal atrial tachycardia; R-MI: Reinfarction of the myocardium; UTVR: Urgent target vessel revascularization; MR/T: Myocardial rupture/tamponade; ARF: Acute renal failure; SSH: Sustained systemic hypotension (lasting < 12-24 h reversed with volume infusion and inotropic support); E-CS: Evolution to cardiogenic shock; +: Considered to be major cardiac complications.

Citation: Lupi-Herrera E, González-Pacheco H, Juárez-Herrera &, Espinola-Zavaleta N, Chuquiure-Valenzuela E, Villavicencio-Fernández R, Peña-Duque MA, Ban-Hayashi E, Férez-Santander S. Primary reperfusion in acute right ventricular infarction: An observational study. World J Cardiol 2014; 6(1): 14-22
URL: https://www.wjgnet.com/1949-8462/full/v6/i1/14.htm
DOI: https://dx.doi.org/10.4330/wjc.v6.i1.14