Eligibility for and benefit of thrombolytic therapy in inferior myocardial infarction: Focus on the prognostic importance of right ventricular infarction

Zehender, Manfred; Kasper, Wolfgang; Kauder, Elisabeth; Geibel, Annette; Schönthaler, Martin; Olschewski, Manfred; Just, Hanjörg

doi:10.1016/0735-1097(94)90289-5

Cited by 85 publications

(44 citation statements)

References 39 publications

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“…23,24 Zehender and coworkers suggested that thrombolytic therapy reduced the in-hospital mortality and complication rate for patients with an inferior ventricular infarction with involvement of the right ventricle. 25 We also reported a similar finding in patients treated with thrombolysis during the acute phase of RVI. 7 Bowers and colleagues, in a PTCA-controlled study, suggested that complete reperfusion improves right ventricular function and the clinical outcome in patients with RVI.…”

Section: Discussionsupporting

confidence: 71%

Doppler echocardiographic evaluation of right ventricular function in patients with right ventricular infarction.

Mattioli

Vandelli

Mattioli

2000

Journal of Ultrasound in Medicine

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The aim of the present study was to assess the utility of the myocardial performance index in patients with right ventricular infarction. During the study period, 120 patients were evaluated: 50 patients had a right ventricular infarction and 70 patients had an inferior left ventricular infarction without right ventricular involvement. On admission, an echocardiogram was obtained from all patients prior to the initiation of thrombolytic therapy. The right ventricular myocardial performance index was calculated, as were the Doppler‐derived parameters of the right side of the heart. All patients with right ventricular infarction had undergone a right ventricular dilation, compared with 70 patients with left ventricular infarction (right ventricular end diastolic diameter 32 ± 13 versus 26 ± 24 mm; P < 0.01) and increased areas (diastolic area 24.8 ± 9.9 versus 15.1 ± 6.8 cm2; P < 0.01). Tricuspid regurgitation was detected in 26 patients. The mean peak velocity of tricuspid regurgitation was 3.8 ± 0.8 m/s. The Doppler intervals, isovolumetric contraction times (136 ± 30 versus 49 ± 11 ms; P < 0.01), and relaxation times (71 ± 28 versus 37 ± 9 ms; P < 0.01) were prolonged in patients with right ventricular infarction, whereas the ejection time was significantly reduced (250 ± 31 versus 330 ± 26 ms; P < 0.001). The myocardial performance index was significantly increased in patients with right ventricular infarction (0.85 ± 0.2 versus 0.26 ± 0.1; P < 0.01). The inferior vena cava collapse was reduced in all patients with right ventricular infarction (35 ± 20%). The right ventricular myocardial performance index was a useful indicator of right ventricular performance in patients with right ventricular infarction. The use of echocardiographic parameters of the right side of the heart and Doppler echocardiographic parameters of right ventricular function provides a reliable diagnosis of right ventricular infarction.

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Section: Discussionsupporting

confidence: 71%

Doppler echocardiographic evaluation of right ventricular function in patients with right ventricular infarction.

Mattioli

Vandelli

Mattioli

2000

Journal of Ultrasound in Medicine

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“…Several of these observations [4,5] have quantified the degree of risk RVI contributes to the overall risk of death in patients with acute MI, but no work has established any prognostic measure within RVI patients alone. The development of the TIMI risk score [8] has created a useful tool with which to risk-stratify patients with acute MI.…”

Section: Discussionmentioning

confidence: 99%

“…While previous work has established the prognostic role of RVI in patients with inferior MI [3][4][5] , no work to date has attempted to stratify risk among patients with RVI.…”

Section: Introductionmentioning

confidence: 99%

Strong predictive value of TIMI risk score analysis for in-hospital and long-term survival of patients with right ventricular infarction

Gumina¹

2002

European Heart Journal

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“…Successful thrombolysis improves survival in patients with RVI, while the absence of reperfusion is associated with persistent dysfunction of the right ventricle and increased mortality [8][9][10][11]. Unsuccessful recanalization of the infarcted artery during fibrinolytic therapy occurs primarily in patients with proximal occlusion of the right coronary artery.…”

Section: Introductionmentioning

confidence: 99%

“…The treatment of these patients involves primarily early reperfusion. Reperfusion, either by thrombolysis or percutaneous coronary intervention (PCI) enhances the recovery of RV function and improves clinical outcome and survival [8][9][10].…”

Section: Introductionmentioning

confidence: 99%

Predictors of In-Hospital Mortality in Patients with Acute Inferior Infarction of the Left Ventricle Accompanied by Right Ventricular Infarction when Treated with Percutaneous Coronary Intervention

Ninkovic¹,

Perunicic²

2013

J Clin Exp Cardiolog

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Introduction: Right ventricular infarction (RVI) significantly increases the risk of in-hospital mortality in patients with acute inferior infarction of the left ventricle (AIILV). The present study evaluated pre-procedural and intra-procedural predictors of in-hospital mortality in patients with AIILV, accompanied by right RVI, when treated with primary percutaneous coronary intervention (PCI).Methods: 237 patients with acute inferior infarction of the left ventricle accompanied with RVI and treated with PCI were admitted to the Coronary Care Unit at Clinical Centre of Serbia, from 2007 until 2009. In-hospital mortality was 4.2%. Results: Using a multivariate logistic regression model, two independent risk-factors for in-hospital mortality were identified: cardiogenic shock caused by right ventricular insufficiency (54.5% vs. 4.5% without cardiogenic shock, p=0.002) and post-procedural TIMI flow <3 (50.0% with TIMI flow <3 vs. 5.6% with TIMI flow 3, p=0.026). In the group of patients without cardiogenic shock, independent risk-factors of inhospital mortality were Killip class >1 (p = 0.019) and previous PCI (p=0.021). Conclusions and clinical implications:Cardiogenic shock and post-procedural TIMI flow <3 in the infarcted artery are independent predictors of in-hospital mortality. In patients without cardiogenic shock, the risk for in-hospital mortality correlates with the degree of left ventricular insufficiency and previous PCI.

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Eligibility for and benefit of thrombolytic therapy in inferior myocardial infarction: Focus on the prognostic importance of right ventricular infarction

Abstract: During acute inferior myocardial infarction, the right precordial electrocardiogram is a simple but promising variable to identify a subgroup of patients with an unfavorable course who will benefit most from thrombolytic therapy.

Cited by 85 publications

References 39 publications

Doppler echocardiographic evaluation of right ventricular function in patients with right ventricular infarction.

Doppler echocardiographic evaluation of right ventricular function in patients with right ventricular infarction.

Strong predictive value of TIMI risk score analysis for in-hospital and long-term survival of patients with right ventricular infarction

Predictors of In-Hospital Mortality in Patients with Acute Inferior Infarction of the Left Ventricle Accompanied by Right Ventricular Infarction when Treated with Percutaneous Coronary Intervention

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