Trend of decreased incidence and mortality of right ventricular infarction in association with increased use of reperfusion therapy; results from over 30-year database of acute myocardial infarction

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Purpose: Inferior myocardial infarction complicated by right ventricular infarction (RVI) is associated with a greater risk of in-hospital mortality and morbidity. However, it remains unclear whether the incidence of RVI and the mortality rate have been changed by evolving therapeutic strategies of early reperfusion therapy. We also evaluated the potential determinant for in-hospital death in those particular patients, who were characterized as low cardiac output syndrome, by using over 30-year database of 5894 acute myocardial infarction (AMI). Methods: Present study included a total of 1874 consecutive inferior AMI patients (M/F; 1464/410, age 66±12 [SD] years) who admitted to our institution between 1979 and 2011. We divided them into 3 groups in chronological order; 1st interval (n=490; 1979 to 1989), 2nd interval (n=600; 1990 to 2000) and 3rd interval (n=784; 2001 to 2011). Results: Over 30 years, the incidence of RVI decreased progressively (1st; 24.9%, 2nd; 16.7%, 3rd; 15.1%, P<0.001) in parallel with a progressive use of reperfusion therapy (1st; 3%, 2nd; 55%, 3rd; 79%, P<0.001) (Figure A). Among 340 patients with RVI, there was a progressive reduction in the mortality rate (1st; 12.4% to 3rd; 5.1%, P=0.04) with an increased use of reperfusion therapy (1st; 4% to 3rd; 97%, P<0.001) (Figure B). In multivariate analysis, no reperfusion (OR 1.6-12.0, P=0.002), previous infarction (OR 1.1-8.1, P=0.04), age ≥70years (OR 1.1-7.5, P=0.02) and Killip class ≥2 (OR 1.9-10.9, P<0.001) were the independent predictor for in-hospital death in patients with RVI. ![Figure][1] Figure 1. A. Incidence of RVI in inf-AMI. B. Mortality of RVI patients. Conclusion: These findings indicate that the incidence of RVI and its mortality rate decreased from 1979 to 2011 with greater use of reperfusion therapy. Patients complicating Killip class ≥2 left heart failure is one of the high-risk subsets of RVI. [1]: pending:yes