[Effect of reperfusion therapy on the prognosis of acute myocardial infarction complicated by left heart failure: prediction based on the acute course of left ventricular heart failure].
This study evaluated the correlation between the acute course and prognosis of patients with acute myocardial infarction complicated by heart failure. Heart failure was defined as a mean pulmonary capillary wedge pressure equal to or greater than 20 mmHg with radiographic evidence of pulmonary congestion during hospitalization in the coronary care unit. A total of 77 heart failure patients underwent primary percutaneous transluminal coronary angioplasty or thrombolysis. Twelve patients who died within the first 3 days (group I) had a higher incidence of unsuccessful reperfusion (50 vs 19%, p < 0.05) and cardiogenic shock (64 vs 4%, p < 0.01), compared with the 65 patients who survived at least the initial 4 days (group II). These 65 patients were classified into three subgroups according to the course of heart failure: early regression type (group IIA, n = 38); prolonged type (group IIB, n = 18); delayed-onset type (group IIC, n = 9). Patients in group IIB had a higher incidence of multivessel disease than group IIA. Patients in group IIC had a higher incidence of unsuccessful reperfusion. Cardiac index in group IIB was lower than in group IIA (2.50 +/- 0.70 vs 1.91 +/- 0.39 l/min/m2). Changes in left ventricular ejection fraction were 4.1 +/- 9.2% in group IIA, -6.6 +/- 16.8% in group IIB, and 0.9 +/- 7.3% in group IIC. The hospital mortality rate was 0% in group IIA, 11% in group IIB, and 33% in group IIC, the reinfarction rate was 0, 17 and 22%, and sustained arterial patency was demonstrated in 81, 62 and 43%, respectively.(ABSTRACT TRUNCATED AT 250 WORDS)
Yamamoto
H
H
Department of Cardiology, Tsuchiya General Hospital, Hiroshima.
Hayashi
Y
Y
Oka
Y
Y
Nakaoka
K
K
Sakuma
T
T
Oiwa
J
J
Matsumoto
T
T
Tsuchiya
T
T
D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D006333:Heart Failure / Q000145:classification / Q000209:etiology*; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D009203:Myocardial Infarction / Q000401:mortality / Q000628:therapy*; D015425:Myocardial Reperfusion; D011379:Prognosis; D015996:Survival Rate; D014568:Urokinase-Type Plasminogen Activator / Q000627:therapeutic use; D018487:Ventricular Dysfunction, Left / Q000175:diagnosis*
D014568:Urokinase-Type Plasminogen Activator