Full recovery of contraction late after acute myocardial infarction: determinants and early predictors.
OBJECTIVE
To assess the relative value of electrocardiographic, echocardiographic, angiographic, and in-hospital therapeutic indices for predicting late functional recovery after acute myocardial infarction, and to determine the variables associated with absence of recovery, partial recovery, and full recovery.


METHODS
Prospective observational follow up study.


METHODS
Teaching hospital.


METHODS
74 consecutive patients with a first uncomplicated acute myocardial infarct.


METHODS
Dobutamine-atropine stress echocardiography was performed mean (SD) 5 (2) days after the acute event. Quantitative angiography was available in all patients before hospital discharge. A follow up resting echocardiogram was obtained 12 (2) months later.


RESULTS
Functional recovery (partial, n = 18; full, n = 27) was observed in 45 of the 74 patients. Recovery was associated with earlier thrombolytic treatment (p = 0.008), earlier peak concentration of creatine kinase (p = 0.009), greater contractile reserve (p = 0.0001), non-Q wave acute myocardial infarction (p = 0.002), and more frequent elective angioplasty of the infarct related vessel (p = 0.0004). Three independent variables were selected stepwise from multivariate analysis for predicting late recovery: contractile reserve (chi(2) = 24.2, p < 0.0001); non-Q wave infarction (chi(2) = 15.7, p = 0.0001); and the time from symptom onset to thrombolysis (chi(2) = 4.94, p = 0.026). Three independent variables predicted full recovery: contractile reserve (chi(2) = 17.2, p = 0.0001); non-Q wave infarction (chi(2) = 10.1, p = 0.0016); and elective angioplasty of the infarct related artery (chi(2) = 4.53, p = 0.033). Only contractile reserve (chi(2) = 17.0, p < 0.001) was selected from the multivariate analysis for its ability to distinguish between partial recovery and absence of recovery.


CONCLUSIONS
Late recovery of contraction relates to earlier treatment, which is associated with lower infarct size unmasked by a non-Q wave event and the presence of contractile reserve. Elective coronary angioplasty of the infarct related artery before hospital discharge is associated with full recovery.
Lancellotti
P
P
Division of Cardiology, University Hospital of Liège, B-4000 Liège, Belgium.
Albert
A
A
Berthe
C
C
Piérard
L A
LA
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015906:Angioplasty, Balloon, Coronary; D002316:Cardiotonic Agents; D017023:Coronary Angiography; D004280:Dobutamine; D004562:Electrocardiography; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009200:Myocardial Contraction / Q000502:physiology*; D009203:Myocardial Infarction / Q000000981:diagnostic imaging / Q000503:physiopathology* / Q000628:therapy; D011379:Prognosis; D011446:Prospective Studies; D012307:Risk Factors; D014463:Ultrasonography
D002316:Cardiotonic Agents; D004280:Dobutamine