Right ventricular parameters significantly improved at 4 months in STEMI patients with acute or chronic right coronary artery occlusion, irrespective of CTO percutaneous coronary intervention.
Cohort (n=174)
Blinded core laboratory
Yes
Does right coronary artery involvement affect right ventricular function recovery in STEMI patients with concurrent CTO?
Right ventricular function parameters significantly improve in STEMI patients with acute or chronic RCA occlusion, and RV global longitudinal strain independently predicts functional status at 4 months.
Absolute Event Rate: -26% vs -31%
p-value: p=0.006
The right ventricle (RV) is frequently involved in ST-segment elevation myocardial infarction (STEMI) when the culprit or concurrent chronic total occlusion (CTO) is located in the right coronary artery (RCA). We investigated RV function recovery in STEMI-patients with concurrent CTO. In EXPLORE, STEMI-patients with concurrent CTO were randomized to CTO percutaneous coronary intervention (PCI) or no CTO-PCI. We analyzed 174 EXPLORE patients with serial cardiovascular magnetic resonance imaging RV data (baseline and 4-month follow-up), divided into three groups: CTO-RCA (CTO in RCA, culprit in non-RCA; n = 89), IRA-RCA (infarct related artery IRA in RCA, CTO in non-RCA; n = 56), and no-RCA (culprit and CTO not in RCA; n = 29). Tricuspid annular plane systolic excursion (TAPSE), RV ejection fraction (RVEF), RV global longitudinal strain (GLS) and free wall longitudinal strain (FWLS) were measured. We found that RV strain and TAPSE improved in IRA-RCA and CTO-RCA (irrespective of CTO-PCI) at follow-up, but not in no-RCA. Only RV FWLS was different among groups at baseline, which was lower in IRA-RCA than no-RCA (- 26.0 ± 8.3% versus - 31.0 ± 6.4%, p = 0.006). Baseline RVEF, RV end-diastolic volume and TAPSE were associated with RVEF at 4 months. RV function parameters were not predictive of 4 year mortality, although RV GLS showed additional predictive value for New York Heart Association Classification > 1 at 4 months. In conclusion, RV parameters significantly improved in patients with acute or chronic RCA occlusion, but not in no-RCA patients. RV FWLS was the only RV parameter able to discriminate between acute ischemic and non-ischemic myocardium. Moreover, RV GLS was independently predictive for functional status.
Veelen et al. (Thu,) conducted a cohort in ST-segment elevation myocardial infarction with concurrent chronic total occlusion (n=174). Infarct-related artery in right coronary artery (IRA-RCA) vs. No right coronary artery involvement (no-RCA) was evaluated on Baseline right ventricular free wall longitudinal strain (RV FWLS) (p=0.006). Right ventricular parameters significantly improved at 4 months in STEMI patients with acute or chronic right coronary artery occlusion, irrespective of CTO percutaneous coronary intervention.