Thrombolytic therapy in right ventricular infarction

Abstract

Summary Right ventricular (RV) involvement during acute inferior myocardial infarction is common and considered to be of prognostic relevance. It was speculated that particularly those patients with RV involvement would profit most from the use of thrombolytic therapy and thus are the key patient group to understanding controversial results on the overall clinical benefit of using thrombolysis during acute inferior myocardial infarction. In 200 consecutive patients with acute inferior myocardial infarction we assessed the eligibility for thrombolytic therapy and the prognostic impact of RV infarction in patients eligible or non-eligible for reperfusion therapy. Prognostic analyses were based on the in-hospital period and a 1–6-year follow-up (mean: 36±11 months). When based on ST-segment elevation in V4R, known as a reliable predictor for RV infarction (sensitivity 88%; specificity 78%; diagnostic efficiency 83%), 107 patients (54%) presented with evidence of RV ischemia. Seventy-one patients (36%) were found eligible for thrombolytic therapy. These patients showed a lower mortality (6/71 patients, 8%) and complication rate (22/71 patients, 31%) compared to patients non-eligible for thrombolysis (mortality: 32/129 patients, 25%; P RV infarction is a common complication of acute inferior myocardial infarction, determines an unfavourable inhospital prognosis and identifies patients who will profit most from using thrombolytic therapy.