Early versus late congestive heart failure after initially uncomplicated anterior wall acute myocardial infarction.
We determined the incidence and clinical, noninvasive, and angiographic variables contributing to postdischarge early (< or = 3 months) and late (> 3 months) congestive heart failure (CHF) after anterior wall acute myocardial infarction. The patient cohort consisted of 94 consecutive patients < 65 years of age who underwent predischarge exercise thallium-201 planar scintigraphy, rest radionuclide angiography, and coronary arteriography. At a mean of 49 months of follow-up, 10 of the 68 medically managed patients developed early CHF, and 10 had late CHF. The 10 patients with early CHF had significantly higher peak creatine kinase values (2,494 vs 1,032 IU/L, p = 0.01), and at discharge, a lower left ventricular (LV) ejection fraction (28 +/- 11% vs 41 +/- 11%, p < 0.02), more persistent thallium-201 defects (3.4 +/- 1.2 vs 2.1 +/- 1.2, p < 0.02), and fewer stress-induced redistribution defects (1.4 +/- 1.1 vs 0.4 +/- 1.1, p < or = 0.05) than those with late CHF. The early group had less multivessel disease (40% vs 90%, p < or = 0.03). Fifty percent (5 of 10) of patients who developed late CHF did so after a recurrent infarction compared with 10% (1 of 10) in the early CHF group (p < 0.07) and 8% in the group without CHF (p < 0.003). The 26 patients who underwent bypass surgery within 3 months had an LV ejection fraction and extent of ischemia and extent of angiographic stenoses comparable to patients with late CHF. None required hospitalization for CHF or had sustained a recurrent infarction.(ABSTRACT TRUNCATED AT 250 WORDS)
Lystash
J C
JC
Department of Medicine, University of Virginia Health Sciences Center, Charlottesville 22908, USA.
Gibson
R S
RS
Watson
D D
DD
Beller
G A
GA
D000328:Adult; D000704:Analysis of Variance; D017023:Coronary Angiography / Q000706:statistics & numerical data; D005260:Female; D005500:Follow-Up Studies; D015637:Gated Blood-Pool Imaging / Q000706:statistics & numerical data; D006321:Heart / Q000000981:diagnostic imaging; D006333:Heart Failure / Q000175:diagnosis / Q000209:etiology* / Q000401:mortality / Q000628:therapy; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications* / Q000175:diagnosis / Q000401:mortality / Q000628:therapy; D011446:Prospective Studies; D013794:Thallium Radioisotopes; D013997:Time Factors; D016896:Treatment Outcome
D013794:Thallium Radioisotopes