Influence of late reopening of the infarct-related artery on left ventricular remodelling after myocardial infarction
Autor: | J.-Y. Rozand, Alec Vahanian, J.-P Bassand, C. Bauters, F. Andre, J.-F. Viel, Gilles Grollier, J.-L. Petit, Nicolas Meneveau, D. Beurrier |
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Rok vydání: | 1997 |
Předmět: |
medicine.medical_specialty
Ventricular End-Systolic Volume medicine.diagnostic_test business.industry medicine.medical_treatment Infarction Percutaneous coronary intervention Left ventricular hypertrophy medicine.disease Surgery Restenosis Internal medicine Angioplasty Angiography cardiovascular system medicine Cardiology cardiovascular diseases Myocardial infarction Cardiology and Cardiovascular Medicine business |
Zdroj: | European Heart Journal. 18:1261-1268 |
ISSN: | 1522-9645 0195-668X |
DOI: | 10.1093/oxfordjournals.eurheartj.a015437 |
Popis: | Aim This trial was undertaken to assess the impact of late reopening of the infarct-related artery on left ventricular remodelling in post-myocardial infarction patients. Methods One hundred and fifty seven patients with recent myocardial infarction were routinely submitted to delayed (second week) catheterization. They also underwent systematic angioplasty of a significantly narrowed infarct-related artery with a suitable anatomy, or reopening of a totally occluded infarct-related artery, and repeat follow-up catheterization after 4 months. Changes in left ventricular ejection fraction, left ventricular volumes, and percent of regional hypokinesia were assessed over the study period. Results One hundred and thirty-two patients had two interpretable left ventriculograms and two interpretable coronary angiograms. At initial angiography, 56 out of 96 patients with a patent infarct-related artery were successfully submitted to percutaneous coronary angioplasty, of whom 25 had restenosis and eight had total reocclusion at follow-up angiography. Percutaneous transluminal coronary angioplasty was not attempted in the remaining 40 patients due to unsuitable anatomy in 18 or a nonsignificant lesion in 22. The infarct-related artery was totally occluded in 36 patients at initial angiography, and successfully reopened by means of angioplasty in 19, of whom seven showed a reocclusion at follow-up angiography. The independent predictors of left ventricular enlargement, identified by means of multivariate regression analysis, were initial stroke volume index 50 ml.m−2 (odds ratio=7·1, 95% confidence interval=[1·5; 25·8]), anterior infarct location (odds ratio=4·1, 95% confidence interval=[1·4; 11·5]) and reocclusion of the infarct-related artery (odds ratio=7·3, 95% confidence interval=[1·3; 27·3]). Angioplasty of a patent but significantly narrowed infarct-related artery was not found predictive. Conclusion This study demonstrates that reocclusion of a previously open infarct-related artery, as well as the initial low stroke volume index, enlarged end-systolic volume index and anterior infarct location are independent predictors of long-term left ventricular enlargement. These results emphasize the impact of long-term sustained patency of the infarct-related artery on the prevention of left ventricular dysfunction. The need for a larger randomized trial is recognised. |
Databáze: | OpenAIRE |
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