Current therapy of the right ventricle myocardial infarction.

BACKGROUND Acute myocardial infarction of the right ventricle (AMI-RV) is a separate subgroup within the scope of inferoposterior infarction of the left ventricle. It still represents the population of patients at high risk due to numerous, often hardly predictable complications and high mortality rate. METHODS In fifteen-year period (1987-2001) 3,765 patients with the acute myocardial infarction (AMI) of different localizations of both sexes--2,283 males and 1,482 females of the average age 61.4 +/- 4.6 years were treated in our institution. Anterior myocardial infarction was diagnosed in 2,146 (56.9%) patients, inferior in 1,619 (43.1%) patients, out of whom right ventricular infarction (RVI) was confirmed in 384 (23.7%). Thrombolytic therapy was administered in 163 (42.4%) patients with RVI, and in 53 (41.7%) of these patients balloon dilatation was performed with coronary stent implantation in 24 (45.2%). RESULTS Favorable clinical effect of the combined thrombolytic therapy and percutaneous transluminal coronary angioplasty (PTCA) was achieved in 51 (96.1%), and in only 2 (3.9%) of patients the expected effect wasn't achieved. Myocardial revascularization was accomplished in 6 (3.6%) and 1 patient died. In 3 (3.4%) patients primary balloon dilatation with the implantation of intracoronary stent was performed within 6 hours from the onset of anginal pain. In the other group of 221 (57.5%) patients with RVI who did not receive thrombolytic therapy, or it had no effect, 26 (11.7%) patients died, which indicated the validity and the efficacy of this treatment (p < 0.01). In the whole group of patients with myocardial infarction of the right ventricle 31 (8.1%) died; in the group that received thrombolytic therapy and PTCA 5 (3.1%) died, while in the group treated in a conservative way 26 (11.7%) died. CONCLUSION Combined therapy was successful in the treatment of patients with RVI and should be administered whenever possible, since it was the best prevention of life-threatening complications and the decrease in the mortality of those patients.