Association Between Right Ventricular Dysfunction and Coronary Angiographic Complexity in Patients With Acute Myocardial Infarction

Background and aim Acute myocardial infarction (AMI) remains a major cause of cardiovascular morbidity and mortality worldwide, particularly in low- and middle-income countries. Although right ventricular dysfunction (RVD) has emerged as an important determinant of outcomes in AMI, its relationship with coronary angiographic complexity remains inadequately explored. This study aimed to evaluate the association between RVD and coronary angiographic complexity in patients with AMI. Methods A hospital-based, prospective observational study was conducted at Chittagong Medical College Hospital, Bangladesh, from March 2024 to February 2025. A total of 98 patients with AMI were included via consecutive sampling. Right ventricular function was assessed using echocardiographic parameters, including tricuspid annular plane systolic excursion (TAPSE), S′ velocity, and fractional area change (FAC). Coronary angiographic complexity was evaluated using the SYNTAX score. The data were analyzed using IBM SPSS Statistics for Windows, version 23.0 (released 2015; IBM Corp., Armonk, NY, USA). Appropriate comparative tests and multivariable logistic regression analysis were performed to explore independent predictors while considering the limited number of outcome events. Results The mean age of the participants was 54.9 ± 11.5 years, and 85.71% were male. RVD was significantly associated with intermediate and high SYNTAX scores (p = 0.002). Among patients with RVD, 47.0% had low SYNTAX scores, whereas 26.5% and 26.5% had intermediate and high SYNTAX scores, respectively. In contrast, among patients without RVD, 76.9% had low SYNTAX scores, whereas 14.3% and 6.1% had intermediate and high scores, respectively. Patients with RVD had significantly lower systolic blood pressure (120.9 ± 18.3 vs 132.6 ± 23.5 mmHg, p = 0.013). Echocardiographic parameters, including TAPSE (16.3 ± 4.2 vs 19.2 ± 4.5 mm, p = 0.002) and FAC (25.6 ± 10.7% vs 35.9 ± 11.3%, p < 0.001), were significantly reduced in patients in the intermediate and high SYNTAX score groups. In the multivariable analysis, RVD showed the strongest association with intermediate and high SYNTAX scores (OR = 7.86, 95% CI: 2.53-24.39, p < 0.001), followed by diabetes mellitus (OR = 5.44, 95% CI: 1.78-16.68, p = 0.003). Conclusions RVD was significantly associated with greater coronary angiographic complexity in patients with AMI. It was more common among patients with intermediate and high SYNTAX scores and remained independently associated with increased angiographic complexity. These findings suggest that RVD may serve as a useful noninvasive marker for early risk stratification. Larger multicenter studies are needed to confirm its prognostic significance.