Time Dependence of the Effect of Right Ventricular Dysfunction on Clinical Outcomes After Myocardial Infarction: Role of Pulmonary Hypertension
| Autor: | Sergey Yalonetsky, Doron Aronson, Wisam Darawsha, Jonathan Lessick, Keren Shahar, Shimon Reisner, Yoram Agmon, Diab Mutlak, Robert Dragu, Michael Kapeliovich |
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| Rok vydání: | 2016 |
| Předmět: |
Male
medicine.medical_specialty Time Factors Hypertension Pulmonary Ventricular Dysfunction Right Myocardial Infarction right ventricle infarction 030204 cardiovascular system & hematology Patient Readmission 03 medical and health sciences 0302 clinical medicine Cause of Death Internal medicine medicine.artery pulmonary hypertension medicine Humans Coronary Heart Disease 030212 general & internal medicine Myocardial infarction Mortality Risk factor Aged Proportional Hazards Models Original Research Aged 80 and over Heart Failure business.industry Hazard ratio Middle Aged medicine.disease Pulmonary hypertension Blood pressure medicine.anatomical_structure Ventricle Heart failure Pulmonary artery Cardiology Female Cardiology and Cardiovascular Medicine business |
| Zdroj: | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| ISSN: | 2047-9980 |
| DOI: | 10.1161/jaha.116.003606 |
| Popis: | Background The clinical importance of right ventricular ( RV ) function in acute myocardial infarction is well recognized, but the impact of concomitant pulmonary hypertension ( PH ) has not been studied. Methods and Results We studied 1044 patients with acute myocardial infarction. Patients were classified into 4 groups according to the presence or absence of RV dysfunction and PH , defined as pulmonary artery systolic pressure >35 mm Hg: normal right ventricle without PH (n=509), normal right ventricle and PH (n=373), RV dysfunction without PH (n=64), and RV dysfunction and PH (n=98). A landmark analysis of early (admission to 30 days) and late (31 days to 8 years) mortality and readmission for heart failure was performed. In the first 30 days, RV dysfunction without PH was associated with a high mortality risk (adjusted hazard ratio 5.56, 95% CI 2.05–15.09, P no PH ). In contrast, after 30 days, mortality rates among patients with RV dysfunction were increased only when PH was also present. Compared with patients having neither RV dysfunction nor PH , the adjusted hazard ratio for mortality was 1.44 (95% CI 0.68–3.04, P =0.34) in RV dysfunction without PH and 2.52 (95% CI 1.64–3.87, P RV dysfunction with PH . PH with or without RV dysfunction was associated with increased risk for heart failure. Conclusion In the absence of elevated pulmonary pressures, the risk associated with RV dysfunction after acute myocardial infarction is entirely confined to the first 30 days. Beyond 30 days, PH is the stronger risk factor for long‐term mortality and readmission for heart failure. |
| Databáze: | OpenAIRE |
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