Impact of Right Ventricular Involvement on Bleeding and Mortality in Patients With Right Coronary Artery-Related Myocardial Infarction　- Insights From Nationwide Registry.

BACKGROUND

Right ventricular involvement (RVI) in acute myocardial infarction (AMI) patients is recognized as a high-risk subset. However, its impact on bleeding and mortality is not well defined in patients with right coronary artery (RCA)-related ST-segment elevation acute myocardial infarction (STEMI) undergoing percutaneous coronary intervention (PCI).

METHODS AND

RESULTS

Using data from the multicenter, prospective Japan AMI Registry including 3,411 patients, we analyzed 993 patients with RCA-related STEMI who underwent PCI. The incidence of all-cause mortality and major bleeding, defined as Bleeding Academic Research Consortium Type 3 or 5, was compared between patients with and without RVI. RVI was present in 9% (n=92) of patients. During a 12-month follow-up, RVI was independently associated with an increased risk of all-cause mortality (adjusted hazard ratio [HR] 2.05; 95% confidence interval [CI] 1.11-3.79) and major bleeding (adjusted HR 2.28; 95% CI 1.13-4.57) in Cox analysis, although this bleeding association was attenuated in adjusted competing-risk analysis (adjusted subdistribution HR 1.87; 95% CI 0.90-3.89). Among patients with RVI, those who experienced major bleeding had a significantly higher risk of death (HR 4.88, 95% CI 1.63-14.58).

CONCLUSIONS

In patients with RCA-related STEMI treated with PCI, RVI was associated with increased mortality and appeared to be associated with a higher risk of bleeding.