title: Prognosis of myocardial infarctions involving more than 40% of the left ventricle after acute reperfusion therapy.
abstract: BACKGROUND
  Prior studies based on autopsy data suggest that infarction of more than 40% of the left ventricle necessitates cardiogenic shock and death.
  
  
  RESULTS
  Technetium-99m Sestamibi tomography was used prospectively to measure infarct size at discharge in 166 patients with acute myocardial infarction. Patients with previous myocardial infarction or revascularization were excluded from the trial. Sixteen patients were identified with final infarct sizes > 40% of the left ventricle despite acute reperfusion therapy. These 16 patients (13 men) had a mean age of 63 +/- 10 years; 44% had a previous history of angina. Ten patients had emergent coronary angioplasty only (mean time to percutaneous transluminal coronary angioplasty [PTCA], 6.0 +/- 3.0 hours); 6 had thrombolysis (mean time to tissue plasminogen activator, 4.0 +/- 1.5 hours), of which 2 had rescue PTCA (5 and 3 hours from onset of pain). Of 15 patients who had angiograms after therapy, 15 had open infarct-related arteries. The left anterior descending artery was the infarct-related artery in 14 (9 proximal and 5 distal lesions). Half the patients had only single-vessel disease. Infarct size measured 50 +/- 7% of the left ventricle (range, 42% to 68%). Ejection fraction by radionuclide angiogram was 0.33 +/- 0.09 and 0.38 +/- 0.07 at discharge and 6 weeks, respectively. Hospital complications included shock (1 patient), pulmonary edema (2), angina (3), symptomatic nonsustained ventricular tachycardia (1), transient complete heart block (2), and transient bifascicular block (1). At follow-up (13 +/- 9 months), the patient with shock had died, but the remaining 15 patients were asymptomatic (1 had late PTCA for angina).
  
  
  CONCLUSIONS
  In the interventional and thrombolytic era, patients with large residual myocardial infarctions can survive without heart failure.
authors.affiliation: Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic, Rochester, Minn. 55905.
authors.forename: B D
authors.initials: BD
authors.lastname: McCallister
authors.forename: T F
authors.initials: TF
authors.lastname: Christian
authors.forename: B J
authors.initials: BJ
authors.lastname: Gersh
authors.forename: R J
authors.initials: RJ
authors.lastname: Gibbons
mesh_terms: D015906:Angioplasty, Balloon, Coronary; D005260:Female; D005500:Follow-Up Studies; D006321:Heart / Q000000981:diagnostic imaging*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000628:therapy; D015425:Myocardial Reperfusion / Q000379:methods*; D011379:Prognosis; D011446:Prospective Studies; D011877:Radionuclide Imaging; D017256:Technetium Tc 99m Sestamibi; D015912:Thrombolytic Therapy; D013997:Time Factors; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use
chemical_list: D017256:Technetium Tc 99m Sestamibi; D010959:Tissue Plasminogen Activator