Patency of the infarct-related artery and left ventricular function as the major determinants of survival after Q-wave acute myocardial infarction.
One hundred seventy-two patients with 1-vessel disease documented at predischarge angiography who had been followed for 43 +/- 30 months after an initial Q-wave acute myocardial infarction were retrospectively evaluated to investigate the prognostic value of infarct-related artery patency and left ventricular (LV) function. Multiple logistic regression analysis revealed that only infarct artery patency (Thrombolysis in Myocardial Infarction [TIMI] grades 2-3 vs 0-1) (Z = 2.24; p < 0.05) and end-systolic volume index (Z = -2.67; p < 0.01) were independently related to survival. Sixteen cardiac deaths were observed; all 16 patients had LV dysfunction (defined as end-systolic volume index > 40 ml/m2), and 15 had an occluded infarct-related artery. In the subgroup with LV dysfunction, the 10-year percent survival rate was 20% among patients with TIMI grade 0 to 1 versus 96% with grade 2-3 (p < 0.001). Patency of the infarct-related artery was also the only independent predictor of recurrent ischemia (Z = 2.59; p < 0.01). In conclusion, both infarct-related artery patency and LV function are independent predictors of survival after Q-wave acute myocardial infarction. Patients with normal LV function have an excellent long-term prognosis, which is only partially counterbalanced by the tendency toward clinical instability observed in those with an open infarct-related vessel. However, when an occluded infarct-related artery is observed in the setting of LV dysfunction, the long-term outcome appears to be relatively poor.
Galvani
M
M
Divisione di Cardiologia, Ospedale G.B. Morgagni-L. Pierantoni, Forlí, Italy.
Ottani
F
F
Ferrini
D
D
Sorbello
F
F
Rusticali
F
F
D002306:Cardiac Volume; D003097:Collateral Circulation; D017023:Coronary Angiography; D003326:Coronary Circulation; D003331:Coronary Vessels / Q000473:pathology*; D004562:Electrocardiography; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008875:Middle Aged; D009203:Myocardial Infarction / Q000188:drug therapy / Q000473:pathology* / Q000503:physiopathology*; D011379:Prognosis; D012008:Recurrence; D012189:Retrospective Studies; D013318:Stroke Volume; D015996:Survival Rate; D015912:Thrombolytic Therapy; D014654:Vascular Patency; D016277:Ventricular Function, Left / Q000502:physiology*