Right ventricular (RV)-pulmonary arterial (PA) coupling independently predicts death from all causes in patients with ST-segment elevation myocardial infarction (STEMI), a new post-hoc study shows. These data were reported by Christian Graesser, MD, of the German Heart Centre Munich, TUM University Hospital, Germany, and colleagues, in a manuscript published Thursday online in JACC: Cardiovascular Interventions. RV-PA coupling has the potential to help with prognosis in patients with STEMI who are very ill and undergoing percutaneous coronary intervention (PCI). Investigators in this study examined the use of RV-PA coupling in managing this population. A total of 973 patients with STEMI were retrospectively analyzed and underwent PCI between 2014 and 2023. The median follow-up time was 4.2 years. Echocardiography was used to assess RV-PA. The ratio of tricuspid annular plane systolic excursion (TAPSE) and systolic pulmonary artery pressure (sPAP) were measured (cutoff 0.405 mm/mmHg for TAPSE/sPAP ratio; patients in high- or low-risk groups). Patients who had RV-PA uncoupling had higher all-cause mortality rates (33.30%) compared with patients who had preserved RV-PA coupling (3.04%) (hazard ratio [HR] for 1-year mortality=12.60; 95% confidence interval [CI]=4.49-35.40; p<0.001). RV-PA uncoupling as a predictor of 1-year mortality was confirmed with multivariate analysis. An external validation cohort confirmed all results. The TAPSE/sPAP ratio predicted 1-year mortality more than TAPSE by itself (p=0.018). Limitations of this study include the retrospective nature of the study along with observational data, TAPSE only provided unidimensional assessment of RV and the TAPSE/sPAP ratio was only available in about 75% of the participants. "Our findings highlight the importance of intact coupling between the RV and the pulmonary circulation to maintain hemodynamic equilibrium in critically ill patients,” the authors concluded. Source: Graesser C, Bresha J, Roski F, et al. RV-PA uncoupling is associated with 1-year mortality in ST-segment elevation myocardial infarction. JACC Cardiovasc Interv. 2026 February 5 (Article in Press). Image Credit: iushakovsky – stock.adobe.com