title: Long-term implications of reocclusion on left ventricular size and function after successful thrombolysis for first anterior myocardial infarction.
abstract: BACKGROUND
  Successful thrombolysis can prevent left ventricular dilatation after acute myocardial infarction. However, in almost 30% of patients, reocclusion occurs. The aim of this study was to assess the long-term implications of reocclusion on left ventricular size and function.
  
  
  RESULTS
  Fifty-six patients were studied with two-dimensional echocardiography at baseline (2 +/- 1.6 days) and 5.0 +/- 1.4 years after first anterior myocardial infarction. All patients (a subset of those enrolled in the APRICOT trial) had a patent infarct-related artery when studied < 48 hours after thrombolysis and underwent repeat coronary angiography at 3 months. Baseline characteristics were comparable in patients with (n = 17) and without reocclusion (n = 39). Left ventricular volume indexes were stable in patients without reocclusion. Patients with reocclusion, however, showed a significant increase in end-diastolic volume index (EDVI; P = .008) and end-systolic volume index (ESVI; P = .039). Furthermore, patients without reocclusion demonstrated improvement in wall motion score index (WMSI; P = .0001) and ejection fraction (EF; P = .016), whereas patients with reocclusion did not. After 5 years, patients with reocclusion had significantly larger volume indexes (EDVI, 99 +/- 41 versus 76 +/- 22 mL/m2, P = .007; ESVI, 59 +/- 40 versus 39 +/- 20 mL/m2, P = .017) and more compromised left ventricular function (WMSI, 1.63 +/- 0.33 versus 1.39 +/- 0.32, P = .013; EF, 45 +/- 13% versus 51 +/- 11%, P = .077) than patients without reocclusion. Multivariate analysis identified baseline WMSI and reocclusion as significant independent predictors of left ventricular dilatation.
  
  
  CONCLUSIONS
  Reocclusion of the infarct-related artery within 3 months of successful thrombolysis is associated with left ventricular dilatation and is detrimental to functional recovery of left ventricular function 5 years after first anterior myocardial infarction.
authors.affiliation: Department of Cardiology, Research School Free University Hospital, Amsterdam, Netherlands. cardiol@azvu.nl
authors.forename: F
authors.initials: F
authors.lastname: Nijland
authors.forename: O
authors.initials: O
authors.lastname: Kamp
authors.forename: F W
authors.initials: FW
authors.lastname: Verheugt
authors.forename: G
authors.initials: G
authors.lastname: Veen
authors.forename: C A
authors.initials: CA
authors.lastname: Visser
mesh_terms: D003327:Coronary Disease / Q000150:complications / Q000000981:diagnostic imaging / Q000503:physiopathology*; D004452:Echocardiography; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D017379:Hypertrophy, Left Ventricular / Q000209:etiology* / Q000517:prevention & control; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications / Q000188:drug therapy* / Q000503:physiopathology; D016032:Randomized Controlled Trials as Topic; D012008:Recurrence; D015912:Thrombolytic Therapy; D016277:Ventricular Function, Left