title: Effect of delayed percutaneous transluminal coronary angioplasty of occluded coronary arteries after acute myocardial infarction.
abstract: Whether angioplasty of occluded vessels after myocardial infarction may have beneficial effects on left ventricular function remains unknown. Patients with a first myocardial infarction and thrombolytic therapy who had an occluded infarct-related vessel at delayed coronary angiography were referred systematically for an elective coronary angioplasty performed between 3 and 4 weeks after the myocardial infarction. All patients underwent stress-redistribution-reinjection thallium-201 single-photon emission computed tomography for myocardial viability assessment. Prior angioplasty, a quantitative evaluation of global and regional left ventricular function, was performed. The study group consisted of 38 patients (aged 57 +/- 10 years); 18 had anterior wall infarctions and 20 inferior wall infarctions, but before angioplasty 3 had a patent artery and were excluded. Angioplasty was successful in 30 patients. At follow-up 13 patients (43%) had an occluded coronary artery. In contrast with patients with an occluded coronary artery at follow-up, those with a patent coronary artery had no left ventricular enlargement and had an improvement in both left ventricular ejection fraction (from 48 +/- 9% to 52 +/- 9.8%, p = 0.002) and regional wall motion index (delta = +0.95 SD, p <0.01). In patients with a patent vessel at follow-up, there was a positive correlation between the number of myocardial viable segments and improvement of the infarct zone wall motion (r = 0.52; p = 0.035), and the number of necrotic segments at baseline was positively correlated to the 4-month changes in end-diastolic volume indexes (r = 0.6; p = 0.04). Thus, elective revascularization of occluded coronary arteries with viable myocardium after myocardial infarction improves left ventricular function and lessens remodeling if the artery remains patent during follow-up.
authors.affiliation: Féderation de Cardiologie, Créteil, France.
authors.forename: J
authors.initials: J
authors.lastname: Garot
authors.forename: M
authors.initials: M
authors.lastname: Scherrer-Crosbie
authors.forename: J L
authors.initials: JL
authors.lastname: Monin
authors.forename: P
authors.initials: P
authors.lastname: DuPouy
authors.forename: M L
authors.initials: ML
authors.lastname: Bourachot
authors.forename: E
authors.initials: E
authors.lastname: Teiger
authors.forename: J
authors.initials: J
authors.lastname: Rosso
authors.forename: A
authors.initials: A
authors.lastname: Castaigne
authors.forename: P
authors.initials: P
authors.lastname: Gueret
authors.forename: J L
authors.initials: JL
authors.lastname: Dubois-Randé
mesh_terms: D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D003251:Constriction, Pathologic; D003327:Coronary Disease / Q000150:complications / Q000503:physiopathology / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications* / Q000503:physiopathology; D011446:Prospective Studies; D013318:Stroke Volume; D013997:Time Factors; D016896:Treatment Outcome; D014654:Vascular Patency; D016277:Ventricular Function, Left