Factors Affecting Prognosis Based on Right Coronary Artery Pathologies

• Published in: Eurasian journal of emergency medicine Vol. 18; no. 3; pp. 128 - 136
• Main Authors: Coşkun, Abuzer, Korkmaz, İlhan, Eren, Şevki Hakan
• Format: Journal Article
• Language: English
• Published: Ankara Galenos Publishing House 01-09-2019
• Subjects: Acute coronary syndromes; Coronary vessels; Ejection fraction; Electrocardiography; Emergency medical care; Glucose; Heart attacks; Medical prognosis; Mortality; Veins & arteries
• ISSN: 2149-5807; 2149-6048
• DOI: 10.4274/eajem.galenos.2019.86158

Aim: Blood glucose levels, cardiac troponin (cTn) values within the first 12 hours, ejection fraction (EF), bundle branch block and Gensini scores of patients who were admitted to the emergency department for acute inferior myocardial infarction (AIMI) were compared based on the bundle branch of the occluded right coronary artery (RCA) with regard to prognosis. Materials and Methods: The data of the study were acquired through retrospective review of 212 patients with AIMI (48 women, 164 men; median age=64 years) who applied to the emergency department due to chest pain and who were hospitalized in cardiology clinic between January 2012 and December 2015. The patients were divided into five RCA groups based on the angiography results. The level of mortality and three-vessel disease (TVD) were compared based on age, gender, blood glucose, EF, Gensini score (GS), cTn, bundle branch block, type of myocardial infarction and percentage of the occluded vein. Results: Major percentage of the occluded vein, cTn, high-density lipoproteins, blood glucose, GS, and EF were statistically significant. The most frequent complication that occurred after acute myocardial infarction was ischemic heart failure (IHF) and it was mostly seen in RCA. Mortality, ventricular tachycardia (VT) and acute pulmonary edema (APE) were seen in acute ST-elevated MI that was close to circumflex artery (Cx) and lateral region. Cardiac tamponade or pericardial effusion was more frequent in mid-RCA. IHF, VT, atrioventricular complete block and APE were common in female patients. Male patients had only higher levels of cardiac tamponade and/or pericardial effusion (p<0.05). Mortality rate was 31.3% (n=15) in female patients and 11.6% (n=19) in male patients. Mortality and right bundle branch block were most common in acute inferoposterior myocardial infarction and IHF AIMI, as well as left bundle branch block was most common in inferolateral MI. TVD was more common in infarctions close to Cx, as well as most frequently in RCA when it was compared with the major occluded vein. Conclusion: Diagnosing an acute coronary syndrome and determining its characteristics based on RCA and the involved segment might be a predictive vision for rapidly predicting complications in TVD and mortality.