Strong predictive value of TIMI risk score analysis for in-hospital and long-term survival of patients with right ventricular infarction

Background: While right ventricular myocardial infarction is associated with increased in-hospital morbidity and mortality, prognostic risk factors for in-hospital and long-term mortality are poorly defined. Objectives: To evaluate the prognostic value of TIMI (Thrombolysis in Myocardial Infarction) risk score analysis in patients with right ventricular myocardial infarction (RVI). Design: Retrospective analysis of a community population. Setting: Mayo Clinic Coronary Care Unit. Patients: One hundred and two patients with RVI from 580 consecutive patients from Rochester, Minnesota admitted to the Coronary Care Unit with acute inferior or lateral wall myocardial infarction from January 1988 through March 1998. Measurement: Combined TIMI risk score analysis with in-hospital and long-term mortality. Results: In-hospital morbidity (RVI: 54·9% vs non-RVI: 22·2%; P<0·001) and mortality (RVI: 21·6% vs non-RVI: 6·9%; P<0·001) were increased in patients with RVI. The TIMI risk score predicted risk (per one point increase in TIMI score) for in-hospital mortality (OR 1·23, 95% CI 1·02-1·51, P=0·037) and long-term mortality (OR 1·57, 95% CI 1·25-1·96, P<0.001). Patients with RVI whose TIMI risk score was >4 had significantly worse long-term survival compared to those patients with RVI and TIMI score <4 (P=0·006). Conclusions: In-hospital morbidity and mortality, and long-term mortality are increased by right ventricular infarction and can be accurately predicted by the initial TIMI risk score.