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Predictors of Adverse 30-Day Outcomes After Right Coronary Artery ST-Elevation Myocardial Infarction
Alexander P Bate1,2, Kyle B Franke1, Ethan Nguyen2
1Department of Cardiology, Central Adelaide Local Health Network, Adelaide 5000, Australia.
Insights
Predictors of adverse outcomes in ST-elevation myocardial infarction (STEMI) involving the right coronary artery (RCA) were identified. Compromised right ventricular (RV) function and poor RV marginal branch flow post-PCI independently predicted mortality and cardiogenic shock within 30 days.
Area of Science:
- Cardiology
- Interventional Cardiology
- Cardiovascular Imaging
Background:
- Limited contemporary evidence exists on predictors of adverse outcomes in ST-elevation myocardial infarction (STEMI) affecting the right coronary artery (RCA).
- Understanding these predictors is crucial for improving patient management and outcomes in this specific STEMI population.
Purpose of the Study:
- To identify predictors of adverse 30-day outcomes in patients with STEMI caused by RCA culprit lesions.
- To compare outcomes between STEMI involving RCA and non-RCA culprit lesions.
Main Methods:
- Retrospective cohort study of 320 consecutive patients with acute STEMI undergoing percutaneous coronary intervention (PCI).
- Patients were categorized based on RCA or non-RCA culprit lesions.
- Primary outcome: composite of 30-day all-cause mortality and cardiogenic shock. Echocardiography assessed right ventricular (RV) function (TAPSE, RV S'). TIMI flow in RV marginal branch post-PCI was evaluated.
Main Results:
- The primary composite outcome was similar between RCA and non-RCA groups (12% vs. 15%, p=0.44), but 30-day mortality was lower in the RCA group (2% vs. 8%, p=0.01).
- In the RCA-STEMI cohort, impaired RV longitudinal function (TAPSE < 17 mm or RV S' < 10 cm/s) and Thrombolysis in Myocardial Infarction (TIMI) flow < 3 in the RV marginal branch post-PCI were independently associated with the primary outcome (p=0.04 for both).
- Compromised RV marginal branch flow also predicted higher ICU admission for cardiogenic shock (p<0.01) and heart failure requiring diuresis (p=0.02).
Conclusions:
- In RCA-STEMI patients, compromised RV marginal branch flow and impaired RV function post-PCI are independent predictors of 30-day mortality and cardiogenic shock.
- These findings can aid in the early identification of high-risk individuals.
- Proactive monitoring and early intervention for cardiogenic shock may benefit these patients.
Abstract:
Background: There is limited contemporary evidence on predictors of adverse outcomes in ST-elevation myocardial infarction (STEMI) involving the right coronary artery (RCA). We examined this in a single-centre retrospective cohort study, focusing on 30-day outcomes. Methods: Consecutive patients presenting to an Australian tertiary hospital between May 2022 and April 2024 with acute STEMI who underwent primary percutaneous coronary intervention (PCI) or rescue PCI were eligible. Patients were divided into STEMI due to RCA and non-RCA culprit lesions, and their characteristics were compared. The primary outcome was a composite of 30-day all-cause mortality and cardiogenic shock. Results: Among 320 included patients, the primary composite outcome was similar between the RCA and non-RCA groups (12% vs. 15%, p = 0.44), although 30-day mortality was lower in the RCA-STEMI group (2% vs. 8%, p = 0.01). In the RCA-STEMI cohort, right ventricular (RV) longitudinal dysfunction on echocardiogram, defined as a tricuspid annular plane systolic excursion (TAPSE) < 17 mm or RV tissue doppler lateral annular systolic velocity (RV S') < 10 cm/s (p = 0.04), and Thrombolysis in Myocardial Infarction (TIMI) flow < 3 in the RV marginal branch post-PCI (p = 0.04) were independently associated with the primary outcome. The latter was also associated with a higher risk of intensive care unit admission for cardiogenic shock (p < 0.01) and heart failure requiring inpatient diuresis (p = 0.02). Conclusions: In patients with RCA-STEMI, compromised RV marginal branch flow post-PCI and impaired RV function were independently associated with the composite primary outcome of 30-day all-cause mortality and cardiogenic shock. These characteristics may assist early identification of at-risk individuals who could benefit from pro-active monitoring and early implementation of therapies for cardiogenic shock.
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