Frequency, Risk Factors, and In-Hospital Outcomes of Right Ventricular Involvement in Inferior Wall Myocardial Infarction: A Prospective Cohort Study from Azad Kashmir

Abstract

Objectives: Aim of this study was to determine the frequency, risk factors, and in-hospital outcomes of right ventricular infarction (RVI) in patients presenting with inferior wall myocardial infarction (IWMI). Methodology: This prospective observational cohort study was conducted at the Kashmir Institute of Cardiology, Mirpur, from February to August 2025. A total of 129 patients ≥18 years with confirmed IWMI were consecutively enrolled. RVI was diagnosed using right-sided ECG leads (ST elevation ≥1 mm in V4R) and echocardiographic parameters of RV dysfunction. Results: RVI was identified in 26 of 129 patients (20.2%). Hypertension (OR = 4.09, 95% CI 1.53–10.9, p=0.002), smoking (OR = 2.67, 95% CI 1.09–6.54, p=0.023), hyperlipidemia (OR = 2.38, 95% CI 0.96–5.87, p=0.048), and prior CAD (OR = 4.74, 95% CI 1.38–16.3, p=0.041) were significantly associated with RVI. Patients with RVI had higher rates of cardiogenic shock (OR = 5.89, 95% CI 1.46–23.8, p=0.016), ventricular fibrillation (OR = 13.0, 95% CI 1.3–123.0, p=0.026), and failed thrombolysis (p=0.039). Mortality was higher in RVI patients (7.7% vs. 4.8%) but not statistically significant (OR = 1.63, 95% CI 0.30–8.94, p=0.63). Conclusion: Approximately one-fifth of IWMI patients had concomitant RVI, which was significantly associated with hypertension, smoking, and hyperlipidemia. RVI patients experienced higher in-hospital complications, underscoring the importance of early risk stratification and intensive management.