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2008, Number 4

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Arch Cardiol Mex 2008; 78 (4)

A proposed functional clinical classification predicts in-hospital and long-term survival in the setting of acute right ventricular infarction

Lupi-Herrera E, Chuquiure-Valenzuela E, González-Pacheco H, Juárez-Herrera U, Martínez-Sánchez C, Gaspar J

Language: English
References: 26
Page: 369-378
PDF size: 136.27 Kb.


ABSTRACT

Background: 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


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