Angiographic Predictors for the Development of Right Ventricular Cardiogenic Shock in Patients Presenting with Inferior Wall ST-Elevation MI

Background: Acute right ventricular infarction (RVI) is associated with hemodynamic and electrical complications and worse prognosis.The ability to predict which patients with inferior wall ST-elevation MI will develop right ventricular cardiogenic shock is limited.Methods: Consecutive patients admitted with STEMI secondary to occlusion of the right coronary artery were retrospectively analyzed.The association between demographic, angiographic and clinical characteristics and the development of cardiogenic shock due to right ventricular failure was evaluated.The accuracy of angiographic factors for the prediction of cardiogenic shock was assessed.Results: Out of 152 patients, 14 (9.21%) developed cardiogenic shock because of right ventricular failure.Three of them (21.42%)died during hospitalization.There were no deaths in patients without cardiogenic shock.In the cardiogenic shock group, 92.9% of patients had aculprit lesion in the proximal RCA and 78.6% of patients had multi-vessel coronary disease, compared to 42.8% and 39.1%in patients without shock.Proximal RCA occlusion, multivessel coronary disease, and failure of reperfusion were independent predictors for cardiogenic shock (ORs 15.7, 5.3 and 4.7 respectively).Conclusion: A culprit lesion in the proximal right coronary artery, the presence of multi-vessel disease and failure of reperfusion are strong predictors for the development of cardiogenic shock in patients presenting with inferior wall STEMI.Identification of these simple variables routinely available in the diagnostic angiogram performed upon admission may warrant careful and prolonged monitoring in the ICU, in order to identify early signs of cardiogenic shock.