Objective: The objective of this study was to examine the relationship between right ventricular involvement (RVI) in acute myocardial infarction (AMI) and the increase in mortality and morbidity frequently suggested in the last two decades.
Design: The authors conducted a systematic review and meta-analysis.
Setting: This study was conducted at an academic medical center.
Data Source: The authors reviewed PubMed, BioMedCentral, and the Cochrane database and conducted a manual review of article bibliographies.
Study Selection and Data Extraction: Using a prespecified search strategy, 22 relevant studies involving a total of 7,136 patients with AMI at baseline, of whom 1,963 had RVI (27.5%), were included in a meta-analysis using a random effects model. Pooled relative risks of the impact of RVI on patient mortality and morbidity were calculated.
Main Results: An overall pooled relative risk mortality increase of 2.59 (95% confidence interval, 2.02-3.31) was found (Z = 7.57; p < .00001). RVI in AMI was also associated with a statistically significant increase in all secondary end points assessed, including cardiogenic shock, ventricular arrhythmias, advanced atrioventricular block, and mechanical complications.
Conclusions: Our results support the view that early recognition of RVI, namely by means of right electrocardiographic leads in acute myocardial infarction, may have prognostic value. Whether or not this recognition will permit improvement of outcomes through more aggressive percutaneous coronary intervention would need to be tested in future studies.
LEARNING OBJECTIVES: On completion of this article, the reader should be able to:
1. Describe the criteria to identify patients with acute myocardial infarction who have right ventricular involvement.
2. Explain the impact of right ventricular involvement on outcomes of acute myocardial infarction.
3. Use this information in a clinical setting.
The authors have disclosed that they have no financial relationships with or interests in any commercial companies pertaining to this educational activity.
All faculty and staff in a position to control the content of this CME activity have disclosed that they have no financial relationship with, or financial interests in, any commercial companies pertaining to this educational activity.
Lippincott CME Institute, Inc., has identified and resolved all faculty conflicts of interest regarding this educational activity.
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