| Right ventricular infarction as an independent predictor of prognosis after acute inferior myocardial infarction. | |
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MedLine Citation:
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PMID: 8450875 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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BACKGROUND: Acute inferior myocardial infarction frequently involves the right ventricle. We hypothesized that right ventricular involvement, as diagnosed by ST-segment elevation in the right precordial lead V4R, may affect the prognosis of patients with inferior myocardial infarctions. METHODS: In 200 consecutive patients admitted to the hospital with acute inferior myocardial infarctions, we assessed the prevalence and diagnostic accuracy of ST-segment elevation in lead V4R (as compared with four other diagnostic procedures) to identify right ventricular involvement and its prognostic implications for in-hospital and long-term outcomes. RESULTS: The in-hospital mortality after inferior myocardial infarction was 19 percent, and major complications occurred in 47 percent of the patients. The presence of ST-segment elevation in lead V4R in 107 patients (54 percent) was highly predictive of right ventricular infarction (sensitivity, 88 percent; specificity, 78 percent; diagnostic accuracy, 83 percent), as compared with the other diagnostic procedures. The patients with ST-segment elevation in lead V4R had a higher in-hospital mortality rate (31 percent vs. 6 percent, P < 0.001) and a higher incidence of major in-hospital complications (64 percent vs. 28 percent, P < 0.001) than did those without ST-elevation in V4R. Multiple logistic-regression analysis showed ST elevation in V4R to be independent of and superior to all other clinical variables available on admission for the prediction of in-hospital mortality (relative risk, 7.7; 95 percent confidence interval, 2.6 to 23) and major complications (relative risk, 4.7; 95 percent confidence interval, 2.4 to 9). The post-hospital course (follow-up, at least 1 year; mean follow-up, 37 months) was similar in patients with and in those without electrocardiographic evidence of right ventricular infarction. CONCLUSIONS: Right ventricular involvement during acute inferior myocardial infarction can be accurately diagnosed by the presence of ST-segment elevation in lead V4R, a finding that is a strong, independent predictor of major complications and in-hospital mortality. Electrocardiographic assessment of right ventricular infarction should be routinely performed in all patients with acute inferior myocardial infarctions. |
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Authors:
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M Zehender; W Kasper; E Kauder; M Sch?nthaler; A Geibel; M Olschewski; H Just |
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Publication Detail:
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Type: Journal Article |
Journal Detail:
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Title: The New England journal of medicine Volume: 328 ISSN: 0028-4793 ISO Abbreviation: N. Engl. J. Med. Publication Date: 1993 Apr |
Date Detail:
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Created Date: 1993-04-13 Completed Date: 1993-04-13 Revised Date: 2010-03-24 |
Medline Journal Info:
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Nlm Unique ID: 0255562 Medline TA: N Engl J Med Country: UNITED STATES |
Other Details:
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Languages: eng Pagination: 981-8 Citation Subset: AIM; IM |
Affiliation:
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Abteilung f?r Kardiologie, Innere Medizin III, Universit?tsklinik Freiburg, Germany. |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Adult Aged Aged, 80 and over Electrocardiography* Female Follow-Up Studies Hospital Mortality Humans Male Middle Aged Multivariate Analysis Myocardial Infarction / diagnosis*, drug therapy, physiopathology Prognosis Prospective Studies Regression Analysis Thrombolytic Therapy Ventricular Function, Right / physiology* |
| Comments/Corrections | |
Comment In:
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N Engl J Med. 1993 Sep 30;329(14):1043
[PMID:
8267730
]
N Engl J Med. 1993 Apr 8;328(14):1036-8 [PMID: 8450857 ] |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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