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Background Right Ventricular (RV) involvement during inferior acute myocardial infarction (AMI) was known to be associated with poor outcome, but might have been mitigated by recent therapeutics. The aim of study was to determine the characteristics and outcomes of patients with RVAMI compared to isolated inferior AMI. Methods This is an observational study that enrolled consecutive patients with RVAMI; age-sex matched patients with isolated inferior AMI served as controls. Results A total of 51 patients with RVAMI were studied (male 39, age 63 ± 16) and compared to 39 age-sex matched patients with isolated inferior AMI. Atherosclerosis risk factors, previous MI and treatment at presentation were similar in both groups. Primary coronary angioplasty was successful in > 90% in both groups. When compared to patients with isolated inferior AMI, patients with RVAMI had more frequent cardiogenic shock at presentation (35% versus 0%, P < 0.01), and in-hospital mortality (18% versus 0%, P < 0.01). Associated factors with in-hospital mortality included age, sex, RV involvement, delay from onset to management, angioplasty, anti GPIIb-IIIa treatment, ejection fraction, creatinine level but not the severity at presentation (including the presence of cardiogenic shock). After discharge from hospital and during a mean 200 weeks follow-up period, mortality increased similarly in both groups. Conclusion RVAMI is still associated with high in-hospital mortality. The severity of initial presentation is not a prognostic factor. Mortality rates after discharge increased very slowly and similarly in both groups. [ABSTRACT FROM AUTHOR]