Risk of myocardium adjacent to infarcted myocardium: electrocardiographic, metabolic and scintigraphic evidence within the first week of acute myocardial infarction.
Atrial pacing was carried out within 5 days of an uncomplicated acute myocardial infarction (AMI) in 28 patients to detect the existence of a menaced area. A positive pacing response (at least 1.0 mm of ST-segment shift) was observed in 23 patients (82%, group I), whereas pacing results were negative in 5 (18%, group II). Pacing-induced electrocardiographic changes involved the leads affected by AMI in patients with transmural necrosis. A well-defined thallium-201 redistribution, mostly localized near or within the AMI site, was present in 10 patients from group I (43%), in 1 from group II (20%), and in 1 of 12 comparable patients (8%) in whom pacing was not performed. During pacing, abnormal lactate metabolism was observed in 11 of 17 patients from group I (65%) and in 0 of 5 from group II (0%). A 90% or greater coronary stenosis of at least 1 artery was found in 19 of 23 patients from group I (83%) and in 1 of 5 from group II (20%); 2- to 3-vessel disease (more than 70% diameter stenosis) was present in 14 patients from group I (61%) and 1 from group II (20%). During a 15-month follow-up (range 9 to 25), effort angina developed in 9 patients from group I (39%) and in none from group II. No deaths or reinfarctions occurred in either group. Thus, very early after a first AMI, most patients have a jeopardized periinfarction area that is usually associated with a critical coronary stenosis and that heralds effort angina in a significant proportion of them.
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J
Figueras
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J
Candell
J
J
Cinca
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R
Segura
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Ortega
J
J
Angel
J
J
Rius
D000328:Adult; D003331:Coronary Vessels / Q000473:pathology; D004562:Electrocardiography; D005500:Follow-Up Studies; D006321:Heart / Q000000981:diagnostic imaging / Q000503:physiopathology; D006801:Humans; D007773:Lactates / Q000378:metabolism; D008875:Middle Aged; D009203:Myocardial Infarction / Q000000981:diagnostic imaging / Q000473:pathology* / Q000503:physiopathology; D009206:Myocardium / Q000473:pathology*; D009336:Necrosis; D011877:Radionuclide Imaging; D012306:Risk; D013793:Thallium; D013997:Time Factors
D007773:Lactates; D013793:Thallium