Short- and Long-Term Outcomes in Patients With Right Ventricular Infarction According to Modalities of Reperfusion Strategies in China: Data From China Acute Myocardial Infarction Registry.

Mengjin Hu,Shubin Qiao,Xiaojin Gao,Fenghuan Hu,Haiyan Xu,Jingang Yang,Ge Chen,Yuan Wu,Yang Wang,Yuejin Yang,Wei Li,Hongmei Yang,Lei Song,Chen Jin

doi:10.3389/fcvm.2022.741110

Abstract

PurposeWe sought to investigate the short- and long-term outcomes in patients with right ventricular infarction in China.MethodsData from China Acute Myocardial Infarction (CAMI) Registry for patients with right ventricular infarction between January 2013 and September 2014 were analyzed.ResultsOf the 1,988 patients with right ventricular infarction, 733 patients did not receive reperfusion therapy, 281 patients received thrombolysis therapy, and 974 patients underwent primary PCI. Primary PCI and thrombolysis were all associated with lower risks of in-hospital (3.1 vs. 12.6%; adjusted OR: 0.48; 95% CI: 0.27–0.87; P = 0.0151 and 5.7 vs. 12.6%; adjusted OR: 0.43; 95% CI: 0.22–0.85; P = 0.0155, respectively), and 2-year all-cause mortality (6.3 vs. 20.9%; adjusted HR: 0.50; 95% CI: 0.34–0.73; P = 0.0003 and 11.0 vs. 20.9%; adjusted HR: 0.59; 95% CI: 0.38–0.92; P = 0.0189, respectively), compared with no reperfusion therapy. Meanwhile, primary PCI was superior to thrombolysis in reducing the risks of in-hospital atrial-ventricular block (4.2 vs. 8.9%; adjusted OR: 0.46; 95% CI: 0.23–0.91; P = 0.0257), cardiogenic shock (5.3 vs. 13.9%; adjusted OR: 0.43; 95% CI: 0.23–0.83; P = 0.0115), and heart failure (8.5 vs. 23.5%; adjusted OR: 0.35; 95% CI: 0.22–0.56; P < 0.0001). Primary PCI could reduce the risk of 2-year major adverse cardiac and cerebrovascular event (19.1 vs. 33.3%; adjusted HR: 0.72; 95% CI: 0.56–0.92; P = 0.0092) relative to no reperfusion therapy, whereas thrombolysis may increase the risk of 2-year revascularization (15.5 vs. 8.7%; adjusted HR: 1.90; 95% CI: 1.15–3.16; P = 0.0124) compared with no reperfusion therapy.ConclusionsTimely reperfusion therapy is essential for patients with right ventricular infarction. Primary PCI may be considered as the default treatment strategy for patients with right ventricular infarction in the contemporary primary PCI era.

Highlights

Right ventricular infarction occurs in a substantial proportion of patients with acute inferior myocardial infarction and is associated with increased rates of morbidity and mortality [1]
No reperfusion and thrombolysis therapies were most likely to be seen in municipal hospitals, whereas primary percutaneous coronary intervention (PCI) practice was most prevalent in provincial hospitals
In the Chinese people-based registry, the main findings of our analysis can be summarized as follows: [1] nearly onehalf patients with right ventricle infarction received primary PCI in China; [2] primary PCI and thrombolysis were all associated with lower risks of in-hospital and long-term all-cause mortality compared with no reperfusion therapy; [3] primary PCI could reduce the risks of in-hospital atrial-ventricular block, cardiogenic shock, heart failure, and long-term major adverse cardiac and cerebrovascular event (MACCE) and revascularization, whereas thrombolysis may increase the risk of long-term revascularization; [4] primary PCI was an independent predictor to decrease both in-hospital (HR: 0.34; 95% confidence interval (CI): 0.21– 0.56; P < 0.0001) and 2-year (HR: 0.39; 95% CI: 0.28–0.55; P < 0.0001) all-cause mortality

Summary

Introduction

Right ventricular infarction occurs in a substantial proportion of patients with acute inferior myocardial infarction and is associated with increased rates of morbidity and mortality [1]. The salutary effects of timely reperfusion have been well-documented, yet the population is based on patients with left ventricular infarction [5], and the strategy to treating right ventricular infarction has not been adequately evaluated and remains little controversial. Some studies suggested that right ventricular function was recovered only after successful reperfusion [4, 6, 7], whereas others reported improvement even in the absence of a patent IRA [8]. These studies were performed before the primary percutaneous coronary intervention (PCI) era, and contemporary primary PCI practice and medical management have evolved and are significantly different from the earlier one. We performed a study designed to investigate the current prevalence, short- and long-term outcomes in Chinese patients with right ventricular infarction in the contemporary primary PCI era, using a large database representing real-world Chinese patients with right ventricular infarction

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Discussion

Conclusion