Primary reperfusion in acute right ventricular infarction: An observational study

doi:10.4330/wjc.v6.i1.14

Advanced Search

BPG is committed to discovery and dissemination of knowledge

Home / Archive / Volume 6, Issue 1

This Article

Academic Content and Language Evaluation of This Article

Citation of this article

Corresponding Author of This Article

Research Domain of This Article

Article-Type of This Article

Open-Access Policy of This Article

Times Cited Counts in Google of This Article

Number of Hits and Downloads for This Article

Total Article Views (6509)

All Articles published online

The chart showing PDF series, WORD series, HTML series, Figures (1-2) series, Tables (1-6) series.

Item

Count

PDF

397

WORD

199

HTML

2882

Figures (1-2)

157

Tables (1-6)

180

Sum=3815

Publishing Process of This Article

The chart showing Browse series, Download series.

Item

Count

Browse

1028

Download

1666

Sum=2694

Jan 26, 2014 (publication date) through Jun 28, 2024

Times Cited of This Article

Times Cited (6)

Journal Information of This Article

Publication Name

World Journal of Cardiology

ISSN

1949-8462

Publisher of This Article

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

Brief Article

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