Comparison of direct PCI and front-loaded tissue plasminogen activator for the treatment of patients with right ventricular infarction - a matched-pairs analysis on 174 patients

Journal of Clinical and Basic Cardiology 2000; 3 (2): 103-106

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Keywords: direkte PCI,  Endpunkt,  rechtsventrikulärer Infarkt,  Thrombolyse,  direct PCI,  Outcome,  right ventricular infarction,  thrombolysis

Patients with inferior acute myocardial infarction (AMI) and concomitant right ventricular infarction (RVI) represent a high-risk population despite early thrombolytic reperfusion. There is accumulating evidence that mechanical reperfusion by means of direct PCI might reverse RV dysfunction and improve prognosis in these patients. Given the lack of randomized trials, we sought to compare the efficiency of a thrombolytic regimen with 100 mg front-loaded recombinant tissue plasminogen activator (rt-PA) versus direct PCI using matched pairs of patients with and without RVI. We enrolled 87 age- and sex-matched pairs of patients presenting within 6 hours after onset of symptoms and assessed prospectively the rates of in-hospital cardiac events (reinfarction, re-ischaemia, death) and predischarge patency of the infarct-related artery (IRA). 30 of 87 pairs (34.5 %) had RVI complicating inferior AMI. These patients had more often systemic hypotension on admission (16.7 vs 40 %, p < 0.01), and suffered more frequently from complete atrioventricular block (35 vs 4 %, p < 0.01). In-hospital mortality rates were insignificantly higher in patients with RVI (15 vs 9 %). Moreover, in-hospital mortality rates were comparable in patients with RVI and non-RVI-AMI regardless whether rt-PA (13 vs 7 %) or direct PCI (16.6 vs 10.5 %) were administered. In the entire cohort, predischarge patency rates of IRA were significantly lower following rt-PA as compared to direct PCI (58.8 vs 93.9 %, p < 0.0001) and particularly among patients with RVI (31.8 vs 96.2 %, p < 0.0001). In addition rates of recurrent ischaemia were significantly higher after rt-PA in patients with RVI (30 vs 3 %, p = 0.012). In conclusion despite lower predischarge patency rates of the IRA, in-hospital mortality rates were comparable after rt-PA and direct PCI both in the entire cohort and among patients with RVI. Further prospective trials are mandatory to clarify the prognostic impact of lower arterial patency rates after thrombolysis in patients with RVI. J Clin Basic Cardiol 2000; 3: 103-6.