Right ventricular (RV)-pulmonary arterial (PA) coupling reflects the relationship between RV contractile function and pulmonary afterload and can be assessed noninvasively by echocardiography. This post hoc analysis published in JACC: Cardiovascular Interventions included 973 patients with ST-segment elevation myocardial infarction (STEMI) who underwent primary percutaneous coronary intervention between 2014 and 2023. 

Patients were analyzed in derivation and validation cohorts with a median follow-up of 4.2 years (Q1–Q3: 2.1-6.7 years). RV-PA coupling was quantified using the ratio of tricuspid annular plane systolic excursion (TAPSE) to systolic pulmonary artery pressure (sPAP). A cutoff of 0.405 mm/mm Hg for TAPSE/sPAP, derived using maximally selected log-rank statistics, stratified patients into high- and low-risk groups.

Patients with RV-PA uncoupling (TAPSE/sPAP < 0.405 mm/mm Hg) had significantly higher 1-year all-cause mortality compared with those with preserved coupling (33.30% [95% CI: 4.65%-53.40%] vs 3.04% [95% CI: 1.40%-4.65%]; HR 12.60; 95% CI: 4.49-35.40; P < 0.001). Receiver-operating characteristic analysis showed that TAPSE/sPAP had a higher area under the curve than TAPSE alone for 1-year mortality (0.732 vs 0.643; P = 0.018). Multivariate analysis confirmed that RV-PA uncoupling was independently associated with 1-year mortality.

These findings suggest that assessment of RV-PA coupling may provide additional prognostic information in STEMI following primary PCI.