[Hemodynamic and coronarographic evaluation for identification of high risk patients following myocardial infarction].
The prognosis of patients surviving myocardial infarction is influenced by a high early mortality rate. The aim of this study was to assess the prognostic value of cardiac catheterisation and coronary angiography performed early after infarction to identify patients at high risk. Two hundred patients including 10 women with an average age of 49.1 +/- 8.6 years surviving (greater than 1 month) primary myocardial infarction underwent haemodynamic and coronary angiographic investigations on average 26 days after the onset of infarction (26 +/- 17 days, range 1 to 90 days). All patients were followed up for average period of 43.2 +/- 13.3 months. The overall mortality rate was 13.5% (27/200). The commonest cause of demise was sudden death: 52% (14/27). Most patients died within the first year of infarction (11/27). Indices of left ventricular function (left ventricular end diastolic pressure and ejection fraction) were significantly more pathological in the patients who died. Similarly, there were many more patients with multivessel (93%) and triple vessel disease (63%) in this sub group (p less than 0,001). Analysis of actuarial survival with respect to ejection fraction demonstrated the prognostic importance of this factor, especially during the first year: 38.5% mortality in patients with ejection fractions below 30%. Triple vessel disease was associated with 13% mortality in the first year. When these two factors were combined, the risk of death in the first year was 50%, so identifying a very high risk subgroup. On the other hand, no deaths were observed in patients with a single coronary lesion and normal left ventricular function (ejection fraction greater than 50%) during 72 months follow-up.(ABSTRACT TRUNCATED AT 250 WORDS)
D000328:Adult; D000368:Aged; D000790:Angiocardiography; D006328:Cardiac Catheterization; D005260:Female; D005500:Follow-Up Studies; D006439:Hemodynamics; D006801:Humans; D008297:Male; D008875:Middle Aged; D009200:Myocardial Contraction; D009203:Myocardial Infarction / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000401:mortality; D011379:Prognosis; D012306:Risk
Bilan hémodynamique et coronarographique pour l'identification des patients à haut risque après un infarctus du myocarde.