Document Detail


In-hospital outcome of elderly patients with acute inferior myocardial infarction and right ventricular involvement.
MedLine Citation:
PMID:  9244209     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: There are some specific high-risk subgroups of patients with acute inferior myocardial infarction, such as older patients and those with right ventricular involvement. However, the clinical implications of right ventricular infarction in elderly subjects have not been studied previously. METHODS AND RESULTS: To determine the clinical impact of right ventricular involvement in elderly patients with inferior myocardial infarction, we studied the in-hospital outcome of 198 consecutive patients > or = 75 years of age with a first acute inferior myocardial infarction according to the presence of ECG or echocardiographic criteria of right ventricular infarction. In patients with right ventricular involvement (41%), in-hospital case fatality rate was 47% (mainly because of nonreversible low cardiac output cardiogenic shock) compared with 10% in patients without right ventricular involvement (P<.001). Patients with right ventricular involvement also had a significantly higher incidence of cardiogenic shock (32% versus 5%), which was independent of left ventricular ejection fraction, complete AV block (33% versus 9%), and interventricular septal rupture (9% versus 0%). After adjustment for age, sex, diabetes, shock on admission, left ventricular systolic dysfunction, and complete AV block, right ventricular infarction remained a powerful independent predictor of in-hospital death (adjusted odds ratio, 4.0; 95% confidence interval, 1.3 to 14.2). CONCLUSIONS: Elderly patients with acute inferior myocardial infarction have a substantially increased risk of death during hospitalization when right ventricular involvement is present. The poorer outcome is due mainly to the high incidence of cardiogenic shock and its infrequent reversibility.
Authors:
H Bueno; R López-Palop; J Bermejo; J L López-Sendón; J L Delcán
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Circulation     Volume:  96     ISSN:  0009-7322     ISO Abbreviation:  Circulation     Publication Date:  1997 Jul 
Date Detail:
Created Date:  1997-08-26     Completed Date:  1997-08-26     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  0147763     Medline TA:  Circulation     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  436-41     Citation Subset:  AIM; IM    
Affiliation:
Department of Cardiology, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
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MeSH Terms
Descriptor/Qualifier:
Acute Disease
Age Factors
Aged
Aged, 80 and over
Female
Heart Ventricles / pathology*,  physiopathology
Humans
Male
Myocardial Infarction / pathology,  physiopathology*,  therapy
Prognosis
Shock, Cardiogenic / physiopathology

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