Right Ventricular Infarction is an Independent Predictor of Short Term Prognosis in Acute Inferior Myocardial Infarction
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1 Right Ventricular Infarction is an Independent Predictor of Short Term Prognosis in Acute Inferior Myocardial Infarction Dr.Md. Nazmul Huda 1, Dr. A R M Saifuddin Ekram 2 Dr. Md. Zahidus Sayeed 3 Dr. Iftekhar Mahmood 4, Dr. Khalilur Rahman 5 Dr. Mir Mahfuzul Hoque Chowdhury 6 Prof. M A Jalil Chowdhury 7
2 Introduction Acute inferior myocardial infarction is generally considered to have more favorable prognosis than anterior myocardial infarction. But, when it is complicated with right ventricular infarction, resulting in hemodynamic instability and increased mortality and hence, it is considered as high risk MI. We hypothesized that RVI, as diagnosed by ST segment elevation in the right precordial lead V 4 R, may affect the prognosis of patients with inferior Myocardial Infarctions.
3 General objective To determine the in-hospital mortality and morbidity of inferior myocardial infarction patients with or without right ventricular infarction.
4 Specific objectives To observe the frequency of RV infarction among the inferior MI patients. To observe the occurrence of complications among the inferior MI patients. To assess the short-term mortality of these patients.
5 Methodology Study type: Descriptive, cross-sectional study. Study time: 2 years (July 2007 to June 2009). Study place: Department of Medicine, Rajshahi Medical College Hospital. Department of Cardiology, Rajshahi Medical College Hospital. Patients: Patients presented with acute inferior myocardial infarction. Sample size: Two hundred forty five (245) samples were calculated One hundred twenty six (126) patients were available during the study period and all were included purposively. Of these 26 patients were excluded according to exclusion criteria and remaining 100 patients were studied. Sampling procedure: Purposive sampling method
6 Results Frequency of right ventricular infarction among the inferior myocardial infarction patients was 31%. Major complications as hypotension and cardiogenic shock occurred in 96.7% and 64.5% patients respectively and in hospital mortality was 41%.
7 Results Major complications as hypotension and cardiogenic shock occurred in 10.1% and 2.8% patients respectively and in hospital mortality were 2.9% among the patients of inferior myocardial infarction without RV infarction. Patients with RV infarction had a 14 times higher risk of death and a 22 times higher risk of major complications during hospitalization.
8 Results Multiple logistic regression analysis showed right ventricular infarction to be independent of and superior to all other clinical variables available on admission for the prediction of inhospital mortality (relative risk, 88.37; 95 percent confidence interval, 7.33 to ; p=0.00) and major complications as hypotension (relative risk, ; 95 percent confidence interval, to ; p=0.00) and cardiogenic shock (relative risk, ; 95 percent confidence interval, to ; p =0.00).
9 Fig 1: Prevalence of complications among the patients Bradycardia 1 H B 2 HB CHB C Shock VT 0 IMI IMI+RVI
10 Fig.9: Death and hospital stays (days) of patients D 1 D2 D3 D4 D5 0 IMI IMI+RVI
11 Conclusions Right ventricular involvement during acute inferior myocardial infarction is a strong independent predictor of major complications and in-hospital mortality. In each patient of inferior myocardial infarction we should specifically look for right ventricular infarction and take necessary precautions.
12 Dr.Md. Nazmul Huda MCPS (Medicine), MD (Internal Medicine) Department of Medicine Rajshahi Medical College, Rajshahi. Dr. A R M Saifuddin Ekram FCPS (Medicine), FACP, PhD, FRCP Professor (C.C.) and Head, Department of Medicine Rajshahi Medical College, Rajshahi. Dr. Md. Zahidus Sayeed MD (Cardiology) Assistant Professor, Department of Cardiology Rajshahi Medical College Rajshahi. Dr. Iftekhar Mahmood PhD Associate Professor, Department of Medicine Rajshahi Medical College Rajshahi. Dr. Khalilur Rahman FCPS (Medicine) Assistant Professor Department of Medicine Rajshahi Medical College Rajshahi. Dr. Mir Mahfuzul Hoque Chowdhury MD (Internal Medicine), Assistant Professor Department of Medicine Rajshahi Medical College Rajshahi. Prof. M A Jalil Chowdhury FCPS (Medicine), MD (Internal Medicine), FACP, FRCP Professor, Department of Medicine Bangabandhu Sheikh Mujib Medical University Dhaka.
13 THANK YOU
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