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Background  The clinical importance of right ventricular ( RV ) function in acute myocardial infarction is well recognized, but the impact of concomitant pulmonary hypertension ( PH ) has not been studied.    Methods and Results  We studied 1044 patients with acute myocardial infarction. Patients were classified into 4 groups according to the presence or absence of  RV  dysfunction and  PH , defined as pulmonary artery systolic pressure >35 mm Hg: normal right ventricle without  PH  (n=509), normal right ventricle and  PH  (n=373),  RV  dysfunction without  PH  (n=64), and  RV  dysfunction and  PH  (n=98). A landmark analysis of early (admission to 30 days) and late (31 days to 8 years) mortality and readmission for heart failure was performed. In the first 30 days,  RV  dysfunction without  PH  was associated with a high mortality risk (adjusted hazard ratio 5.56, 95%  CI  2.05–15.09,  P <0.0001 compared with normal RV and  no PH ). In contrast, after 30 days, mortality rates among patients with  RV  dysfunction were increased only when  PH  was also present. Compared with patients having neither  RV  dysfunction nor  PH , the adjusted hazard ratio for mortality was 1.44 (95%  CI  0.68–3.04,  P =0.34) in  RV  dysfunction without  PH  and 2.52 (95%  CI  1.64–3.87,  P <0.0001) in  RV  dysfunction with  PH .  PH  with or without  RV  dysfunction was associated with increased risk for heart failure.    Conclusion  In the absence of elevated pulmonary pressures, the risk associated with  RV  dysfunction after acute myocardial infarction is entirely confined to the first 30 days. Beyond 30 days,  PH  is the stronger risk factor for long‐term mortality and readmission for heart failure.

Time Dependence of the Effect of Right Ventricular Dysfunction on Clinical Outcomes After Myocardial Infarction: Role of Pulmonary Hypertension