2008, Number 4
A proposed functional clinical classification predicts in-hospital and long-term survival in the setting of acute right ventricular infarction
PDF size: 136.27 Kb.
ABSTRACTBackground: The objectives of the present investigation were to validate the prognostic role of a proposed Clinical Classification [CC], to evaluate the TIMI risk score [RS] and to establish whether the TIMI-RS should incorporate points for patients with acute right ventricular infarction [TIMI-RS-RVI]. Methods and results: A total of 523 RVI patients were classified on clinical and functional basis as: A, without right ventricular failure [RVF], B with RVF and C with cardiogenic shock. The CC was evaluated prospectively among 98 patients with RVI and retrospectively in 425 RVI patients. The TIMI-RS was evaluated prospectively among 622 patients with STEMI [anterior:277, inferior:247, RVI:98], and retrospectively in 425 RVI patients. The CC established differences among the 3-RVI Classes for in-hospital mortality [prospectively and retrospectively; p ‹ 0.01, p ‹ 0.001, respectively] that were maintained at 8 years [p ‹ 0.001]. Patients with anterior and inferior STEMI, but not those with RVI revealed an association between outcome and TIMI-RS [p ‹ 0.001]. Testing for TIMI-RS-RVI did not result a good prognostic tool [ROC = 0.9; excellent discrimination, but with a very poor “clinical calibration”]. Conclusions: The proposed CC allowed prediction of mortality at short- and long-term in the setting of acute RVI. The role of the TIMI-RS should be reevaluated prospectively as a prognostic tool in the scenario of RVI patients
Morrow DA, Antman E, Charlesworth A, Cairns R, Murphy SA, de Lemos JA, et al: TIMI risk score for ST elevation myocardial infarction: A Convenient, Bedside, Clinical Score for Risk Assessment at Presentation. An Intravenous nPA for treatment of Infarcting Myocardium Early II trial substudy. Circulation 2000; 102: 2031-7.
de Lemos JA, Antman E, Giugliano RP, McCabe CH, Murphy SA, Van de Werf F, et al: for the Thrombolysis in Myocardial Infarction [TIMI] 14 Investigators: ST–segment resolution and infarct-related artery patency and flow after thrombolytic therapy. Thrombolysis in Myocardial Infarction [TIMI ] 14 Investigators. Am J Cardiol. 2000; 85: 299-304.
Berger PB, Ruocco NA, Ryan TJ, Jacobs AK, Zaret BL, Wackers FJ, et al and the TIMI Research Group. Frequency and significance of right ventricular dysfunction during inferior wall left ventricular myocardial infarction treated with thrombolytic therapy [results from the Thrombolysis in Myocardial Infarction [TIMI] II trial]. Am J Cardiol 1993; 71: 1148-52.