June 16, 2026Journal of the American College of Cardiology
Effects of thrombolytic therapy in acute inferior myocardial infarction with or without right ventricular involvement
Key result
RV involvement in inferior AMI links to higher 30-day mortality but lacks independent predictive value.
- n=522
Why the study?
Only scant data existed from small studies regarding the impact of reperfusion therapy on survival in patients with right ventricular involvement during inferior AMI.
Does right ventricular involvement independently predict survival in streptokinase-treated patients with inferior acute myocardial infarction?
Population
522 streptokinase-treated inferior AMI patients in the HIT-4 Trial
Comparison
Right ventricular involvement vs no right ventricular involvement
Design
Retrospective subanalysis of a clinical trial
Follow-up
30 days
Authors
Discussion
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Implication
RV involvement adds little to risk stratification beyond infarct size in inferior MI; challenges its independent prognostic role.
Key Points
- This study evaluates how right ventricular involvement affects survival in patients with inferior acute myocardial infarction treated with thrombolytic therapy.
- Assessed right ventricular involvement via ST-segment elevation in lead V4R and classified infarct sizes based on ST-segment deviations in 522 patients.
- Conducted 90-minute coronary angiography in 187 patients for further evaluation.
- Right ventricular involvement was found in 169 patients (32%), with higher 30-day cardiac mortality in those with larger infarct sizes (5.9% vs. 2.5%).
- In patients with large ST, proximal right coronary artery lesions were present in 52% with RVI and 23% without.
- For patients with small ST, cardiac mortality was less than 1% regardless of RVI presence, showing that distal lesions were more common.
Study Design
Type
Cohort (n=522)
Structured PICO
Does right ventricular involvement independently predict survival in streptokinase-treated patients with inferior acute myocardial infarction?
P
Population
522 patients with inferior acute myocardial infarction treated with streptokinase, evaluated for right ventricular involvement and followed for 30 days.
E
Exposure
Presence of right ventricular involvement (RVI) assessed by ST-segment elevation >=0.1 mV in lead V4R
C
Comparator
Absence of right ventricular involvement
O
Outcome
30-day cardiac mortalityhard clinical
Main Result
Absolute Event Rate: 5.9% vs 2.5%
In patients with inferior AMI treated with thrombolysis, right ventricular involvement is associated with larger infarct size and higher 30-day mortality, but is not an independent predictor of survival.
Cite This Study
Zeymer et al. (1998) conducted a cohort in Inferior acute myocardial infarction (n=522). Right ventricular involvement vs. No right ventricular involvement was evaluated on 30-day cardiac mortality. Right ventricular involvement in inferior AMI was associated with higher 30-day cardiac mortality (5.9% vs. 2.5%), but was not an independent predictor of survival.