Does multivessel disease with proximal LAD stenosis increase the prevalence of complex ventricular arrhythmias compared to single-vessel disease in patients with CAD?
In post-MI patients, the presence of multivessel disease with proximal LAD stenosis is associated with a higher risk of complex ventricular arrhythmias and ischemia compared to single-vessel disease, independent of left ventricular ejection fraction.
In this study, 87 consecutive patients with angiographically proven coronary artery disease (CAD, stenosis greater than 75%) underwent 24-h Holter monitoring, 76 of them having had transmural myocardial infarction, a mean of five months before evaluation. Of the total, 51 patients showed single-vessel disease, in 31 (61%) of them with involvement of the left anterior descending (LAD) artery. In 26 patients with proximal LAD stenosis or occlusion and usually large aneurysms and subsequently impaired left ventricular function relatively low prevalence of significant ventricular premature contraction (VPC, Lown greater than or equal to III) was seen. On the contrary in 19 patients with multivessel disease and proximal LAD stenosis advanced forms of VPCs were present in 63% (p less than 0.01). Further both groups differed significantly in the frequency of postinfarction angina (30% vs. 100%; p less than 0.001) and their incidence in positive exercise stress tests (15% vs. 84%; p less than 0.001). Ejection fractions were comparable in both groups (mean 45% vs. 52%). Finally 17 patients with multivessel disease but without proximal LAD lesion did not differ in any of the above mentioned parameters, when compared to the patients with single-vessel disease and proximal LAD stenosis. We conclude that impaired left ventricular function does not sufficiently explain the high risk of sudden death in postmyocardial infarction patients. The coronary and functional status of the surviving myocardium has to be taken into consideration as well.
Köenig et al. (Tue,) studied this question.