Coronary artery diseaseComparison of Late Survival in Patients With Cardiogenic Shock Due to Right Ventricular Infarction Versus Left Ventricular Pump Failure Following Primary Percutaneous Coronary Intervention for ST-Elevation Acute Myocardial Infarction
Section snippets
Study population
Our study population was taken from 2,496 consecutive patients with STEMI treated with primary percutaneous coronary intervention (PCI) without previous thrombolytic therapy at our institution from 1984 to 2004. Patients with chest pain <12 hours in duration (>12 hours for persistent pain or hemodynamic compromise) and with electrocardiographic ST-segment elevation ≥1 mm in ≥2 contiguous leads or left bundle branch block were selected for intervention. Cardiogenic shock occurred before PCI in
Study population
Of 189 patients with cardiogenic shock, shock was caused by LV pump failure in 136 (72%), predominant RV infarction in 30 (16%), mechanical complications in 13 (6.9%), and other causes in 10 (5.3%). In the 30 patients with RV infarction, right coronary occlusion was located in the proximal vessel in 27 and in the mid-vessel in 3. LV ejection fraction data were available in 28 patients (93%), right-sided heart pressure data were available in 22 (73%), electrocardiographic evidence of RV
Discussion
The major finding of this study is that early and late survival after primary PCI for STEMI in patients with cardiogenic shock due to predominant RV infarction are significantly better than those in patients with shock due to LV pump failure. This finding may be partly related to a lower risk profile in patients with shock due to RV infarction. Patients with RV infarction had less diabetes mellitus, fewer previous MIs, less previous coronary bypass surgery, less multivessel coronary artery
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Cited by (53)
Management of Cardiogenic Shock in Patients with Acute Myocardial Infarction
2021, Interventional Cardiology ClinicsComparison of Incidence and Outcomes of Cardiogenic Shock Complicating Posterior (Inferior) Versus Anterior ST-Elevation Myocardial Infarction
2020, American Journal of CardiologyCharacteristics, mortality and prognostic factors of acute right ventricular myocardial infarction: A case-control study
2017, Annales de Cardiologie et d'AngeiologieCitation Excerpt :Third, several factors that had already proven their significance (i.e. age, time to reperfusion, LVEF, creatinine concentration, anticoagulant therapy), but not the presence of initial collapse, were associated with in-hospital mortality. Previous studies reported high mortality rates possibly averaging 25 to 30% of patients with RVAMI [2,5,13]. In these studies, RVAMI was also associated to an increase in long-term mortality [6,14,16].
Right ventricular systolic function as a marker of prognosis after ST-elevation inferior myocardial infarction 5-year follow-up
2016, International Journal of CardiologyCitation Excerpt :The main early prognostic factor in RV MI was the drop in blood pressure in the acute phase of MI and cardiac shock symptoms [12]. Effective reperfusion of the artery responsible for MI by primary coronary intervention leads to a rapid RV function improvement and a better prognosis, also in the group of patients with cardiogenic shock [13–16]. Studies which evaluate the correlation of late RV function with prognosis are scarce.
Impact of thrombus aspiration during primary percutaneous coronary intervention in cardiogenic shock complicating ST-segment elevation myocardial infarction
2013, Cardiovascular Revascularization MedicineCitation Excerpt :Our study shows that, in this population, TA was carried out in about 50% of the patients, who are at lower clinical and angiographic risk. Indeed, the TA group presented a higher rate of right ventricular infarction as cause of CS (which is related with a lower mortality in comparison with left ventricular failure) [19], a higher left ventricular function at baseline, in terms of LVEF, and a lower rate of left main as IRA. Although TA was associated with a lower in-hospital and long-term mortality, this datum was not confirmed by the propensity score analysis.
Acute Right Ventricular Infarction: Insights for the Interventional Era
2012, Current Problems in Cardiology
This study was supported by grants from the LeBauer Cardiovascular Research Foundation and the LeBauer Charitable Research Foundation, Greensboro, North Carolina.