A proposed functional clinical classification predicts in-hospital and long-term survival in the setting of acute right ventricular infarction

background: the objectives of the present investigation were to validate the prognostic role of a proposed clinical classification [cc], to evaluate the timi risk score [rs] and to establish whether the timi-rs should incorporate points for patients with acute right ventricular infarction [timi-rs-rvi]. methods and results: a total of 523 rvi patients were classified on clinical and functional basis as: a, without right ventricular failure [rvf], b with rvf and c with cardiogenic shock. the cc was evaluated prospectively among 98 patients with rvi and retrospectively in 425 rvi patients. the timi-rs was evaluated prospectively among 622 patients with stemi [anterior:277, inferior:247, rvi:98], and retrospectively in 425 rvi patients. the cc established differences among the 3-rvi classes for in-hospital mortality [prospectively and retrospectively; p < 0.01, p < 0.001, respectively] that were maintained at 8 years [p < 0.001]. patients with anterior and inferior stemi, but not those with rvi revealed an association between outcome and timi-rs [p < 0.001]. testing for timi-rs-rvi did not result a good prognostic tool [roc = 0.9; excellent discrimination, but with a very poor "clinical calibration"]. conclusions: the proposed cc allowed prediction of mortality at short- and long-term in the setting of acute rvi. the role of the timi-rs should be reevaluated prospectively as a prognostic tool in the scenario of rvi patients.