Predictors of right ventricular dysfunction and its clinical value after reperfusion of acute right coronary artery occlusion: a single-center retrospective analysis

OBJECTIVE: To investigate independent predictors of right ventricular (RV) dysfunction following successful reperfusion by percutaneous coronary intervention (PCI) in patients with acute right coronary artery (RCA) occlusion, and to assess its association with short-term clinical outcomes. METHODS: This single-center retrospective study enrolled consecutive patients with acute ST-segment elevation myocardial infarction (STEMI) who underwent emergency PCI for acute RCA occlusion. Based on right ventricular fractional area change (RVFAC) measured by echocardiography 24-72 hours post-PCI, patients were divided into an RV dysfunction group (RVFAC < 35%) and an RV normal function group (RVFAC ≥ 35%). Baseline characteristics, laboratory data, angiographic findings, and in-hospital and 30-day outcomes were compared. Multivariable logistic regression was used to identify independent predictors of RV dysfunction. RESULTS: Among 136 patients, 29.4% had right ventricular (RV) dysfunction. These patients were older and had more cardiovascular risk factors. Independent predictors of RV dysfunction included an NLR ≥ 5, lactate ≥ 2 mmol/L, cardiogenic shock (Killip class IV) at admission, and age ≥ 65 years. A composite score of NLR and lactate demonstrated excellent predictive value for RV dysfunction. During hospitalization, patients with RV dysfunction experienced significantly higher rates of cardiogenic shock, malignant arrhythmias, acute kidney injury, and cardiac death. At 30 days, they also had a higher rate of readmission for heart failure. CONCLUSION: In patients with acute RCA occlusion undergoing successful PCI, elevated NLR (≥ 5), hyperlactatemia (≥ 2 mmol/L), cardiogenic shock at admission, and age ≥ 65 years are independent predictors of early postoperative RV dysfunction. RV dysfunction is strongly associated with adverse in-hospital outcomes and increased 30-day heart failure readmission. Early identification of these factors may guide risk stratification and individualized management.