Right Ventricle Infarction in Current Practice: Insights from a Contemporary Registry at a High-Volume Tertiary Center in Brazil

Reichert, Giulia Bonatto; Tietz, Pedro Henrique Torres; Silva, Vitoria; Schmidt, Marcia Moura; Gottschall, Carlos A. M.; de Quadros, Alexandre Schaan

doi:10.36660/ijcs.20250098

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Sumário

Original Article • Int J Cardiovasc Sci 39 • 2026 • https://doi.org/10.36660/ijcs.20250098 linkcopy

Right Ventricle Infarction in Current Practice: Insights from a Contemporary Registry at a High-Volume Tertiary Center in Brazil

Authorship SCIMAGO INSTITUTIONS RANKINGS

Background: Right ventricular (RV) involvement in acute ST-segment elevation myocardial infarction (STEMI) has scarcely been studied in contemporary cardiology practice.

Objective: To evaluate the clinical, angiographic, procedural characteristics and outcomes of patients with STEMI and RV involvement undergoing primary percutaneous coronary intervention (pPCI).

Methods: This prospective cohort included consecutive patients with STEMI presenting within 12 hours of symptom onset and undergoing pPCI between 2009 and 2023 at a high-volume tertiary cardiology center in Brazil. Clinical characteristics and outcomes of patients with RV infarction were compared to those without RV involvement. Continuous and categorical variables were analyzed using appropriate statistical tests, with a significance level of 5% (p < 0.05). Logistic regression models were used to identify independent predictors.

Results: Among 5,611 patients, 13% had RV involvement. These individuals were more frequently female, had right coronary artery as the culprit vessel, had greater thrombotic burden, and more often presented with total atrioventricular block (TAVB). Acute kidney injury (5.8% versus 4.1%, p = 0.03) and stroke (1.6% versus 0.8%, p = 0.04) were more common in the RV group. Thirty-day (10.5% versus 8.7%, p = 0.16) and 2-year mortality (19.5% versus 18.5%, p = 0.11) were higher among patients with RV infarction, although not statistically significant. In multivariable analysis, TAVB and female sex were independently associated with RV involvement. RV infarction was not an independent predictor of 30-day mortality.

Conclusion: In current practice, approximately 1 in 7 STEMI patients present with RV involvement. These patients have a higher-risk profile, though RV infarction was not independently associated with short-term mortality.

Keywords:
Right Ventricular; ST-Segment Elevation Myocardial Infarction; Acute Coronary Syndrome; Myocardial Infarction

			STEMI with RV involvement (n=705)	STEMI without RV involvement (n=4906)	p value
Age, years			61 ± 12	60.8 ± 12	0.44
Female sex, %			40	30	<0.01
White race, %			91	90	0.26
Risk factors for CAD
	FH+, %		22	24	0.09
	Smoking, %		46	41	0.05
	HTN, %		64	62	0.27
	DM, %		27	26	0.26
	DLP, %		30	31	0.32
Past medical history
	MI, %		20	20	0.45
	Stroke, %		6.2	6.5	0.42
	CABG, %		2.5	3.4	0.14
	PCI, %		16	16	0.51
		Angina, %	39	40	0.29
	HF, %		4.2	6.2	0.02
	CKD, %		2.4	2.3	0.49
	Peripheral vascular disease, %		20	16	<0.01
	Severe COPD, %		6.4	4.8	0.06
	Depression, %		16	15	0.23
Admission characteristics
	ASA use, %		24	23	0.30
	TAVB, %		12	2.1	<0.01
	Killip 3 or 4, %		7	7	0.49
	Symptom-to-door time, hours		4:00 (2:11-6:00)	4:05 (2:10-6:39)	0.32
	Door-to-balloon time, minutes		64 (49-84)	67 (50-90)	0.03

			STEMI with RV involvement (n=705)	STEMI without RV involvement (n=4906)	p value
Culprit vessel
	LAD, %		4.4	51	<0.01
	CX, %		3.2	14
	RCA, %		91	32
	LMCA, %		0.3	1.2
Angiographic characteristics
	Three-vessel disease, %		22	19	<0.01
	LMCA lesion, %		3.4	4.0	0.24
		Calcified lesion, %	8.3	9.0	0.59
	High thrombotic burden, %		53	46	<0.01
Procedure aspects
	Radial access, %		60	65	0.01
	Stent diameter, cm		3.27 ± 0.48	3.17 ± 1.15	0.04
	Pre-procedure TIMI grade 3, %		3.4	10	<0.01
	Post-procedure TIMI grade 3, %		90.5	92.2	0.16
	Pre-procedure blush grade 3, %		2.5	7.0	<0.01
	Post-procedure blush grade 3, %		82.5	83.8	0.44
	No reflow, %		3.8	2.2	0.02
	Non-culprit vessel PCI, %		2.8	3	0.57
	IABP, %		2.8	3.1	0.40
	Temporary pacemaker, %		14	2.6	<0.01
	GPIIb/IIIa, %		25	20	0.05

	STEMI with RV involvement (n=705)	STEMI without RV involvement (n=4906)	p value
Success, %	94.7	95.3	0.54
Complication-free, %	83	89.7	<0.01
Dissection, %	2.5	2.2	0.67
Perforation, %	0.1	0.2	1.00
No reflow, %	4.2	3	0.11
Acute occlusion, %	0.6	0.5	0.90
Branch occlusion, %	1.5	1.1	0.43
Other coronary occlusion, %	0.1	0.2	1.00
VT/VF, %	3.9	2.1	<0.01
TAVB, %	3.6	0.5	<0.01
Stroke, %	0	0.2	0.58
Peripheral occlusion, %	0	0.1	1.00
In-room death, %	0.4	0.4	1.00

		STEMI with RV involvement (n=705)	STEMI without RV involvement (n=4906)	p value
In-hospital outcomes
	CABG, %	2.2	2	0.39
	Stroke, %	1.6	0.8	0.04
	AKI, %	5.8	4.1	0.03
	IABP, %	1.3	1.2	0.49
	Mechanical ventilation, %	10	8.5	0.09
	Sepsis, %	4.5	3.8	0.23
	Recurrent MI, %	1.4	1.5	0.49
	SHF, %	2.5	3.4	0.15
	Major bleeding, %	1.9	1.4	0.19
	Minor bleeding, %	2.7	3.6	0.14
	Stent thrombosis, %	0.9	1.3	0.26
	In-hospital mortality, %	9.6	7.4	0.06
Mortality in follow-up
	30 days, %	10.5	8.7	0.16
	1 year, %	14.4	12.2	0.16
	2 years, %	19.5	16.5	0.11

Factor	OR	95% CI	p value
Killip 4	0.87	0.60-1.27	0.48
TAVB at admission	6.48	4.79-8.75	<0.01
Female sex	1.3	1.17-1.41	<0.01
AKI	1.27	0.86-1.88	0.23
Stroke	2.73	2.28-3.64	<0.01

Variable	OR	95% CI	p value
Age > 65 years	2.7	2.2 – 3.4	<0.01
Female sex	1.5	1.2 – 1.9	<0.01
DM	1.5	1.2 – 1.9	<0.01
Multivessel disease	2.0	1.6 – 2.5	<0.01
High thrombotic burden	1.2	1.0 - 1.5	0.03
RV involvement	1.0	0.7 – 1.4	0.77

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[TFN1] ASA: acetylsalicylic acid; CABG: coronary artery bypass grafting; CAD: coronary artery disease; CKD: chronic kidney disease; COPD: chronic obstructive pulmonary disease; DLP: dyslipidemia; DM: diabetes mellitus; FH+: positive family history; HF: heart failure; HTN: hypertension; MI: myocardial infarction; PCI: percutaneous coronary intervention; RV: right ventricular; STEMI: ST-segment elevation myocardial infarction; TAVB: total atrioventricular block.