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December 24, 1992New England Journal of MedicineOpen Access

An Association between Collateral Blood Flow and Myocardial Viability in Patients with Recent Myocardial Infarction

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Why the study?

Does successful angioplasty improve regional wall motion in patients with recent myocardial infarction and an occluded infarct-related artery?

Population

n=43 patients who had a myocardial infarction two days to five weeks earlier, with an occluded…

Comparison

Angioplasty attempted in the occluded… vs Unsuccessful angioplasty.

Design

Cohort

Follow-up

one month

Authors

PSPeter J. SabiaUniversity of VirginiaEPEric R. PowersUniversity of FloridaMRMichael RagostaInterventional / Structural Cardiology

Discussion

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Implication

Successful late angioplasty was associated with improved wall motion post-MI; hypothesis-generating and leaves open causal confirmation by RCTs.

Key Points

  • To determine whether late reperfusion of an occluded infarct-related coronary artery improves regional wall motion and to evaluate if functional recovery correlates with collateral blood flow.
  • Evaluated 43 patients who experienced a myocardial infarction two days to five weeks earlier and underwent attempted angioplasty of the occluded infarct-related artery.
  • Assessed regional wall motion via two-dimensional echocardiography using a five-point scale at baseline and one month post-procedure.
  • Quantified the percentage of the infarct bed receiving collateral flow using myocardial contrast echocardiography.
  • Regional wall motion improved in 78% (25/32) of patients with successful angioplasty compared to 11% (1/9) with unsuccessful angioplasty (P < 0.001).
  • Baseline collateral perfusion inversely correlated with the one-month wall-motion score after successful angioplasty (r = -0.64, P < 0.001).
  • Patients with >50% collateral flow exhibited superior wall motion (P < 0.001) and greater recovery (P = 0.004) than those with ≤50% flow, irrespective of the time elapsed since infarction.

Structured PICO

Does successful angioplasty improve regional wall motion in patients with recent myocardial infarction and an occluded infarct-related artery?

P
Population
n=43 patients who had a myocardial infarction two days to five weeks earlier, with an occluded infarct-related artery.
I
Intervention
Angioplasty attempted in the occluded infarct-related artery.
C
Comparator
Unsuccessful angioplasty.
O
Outcome
Regional wall motion assessed by two-dimensional echocardiography (wall-motion score on a five-point scale) at one month.surrogate

Successful reperfusion of an occluded infarct-related artery late after myocardial infarction improves regional wall motion, and this viability is strongly associated with the presence of collateral blood flow.

Cite This Study

Sabia et al. (1992) studied this question.

synapsesocial.com/papers/69fe7a2ed8476229fea35b79https://doi.org/10.1056/nejm199212243272601

Topics

Echocardiography
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Also Consider

Synapse has enriched 2 closely related papers on similar clinical questions. Consider them for comparative context:

  1. 1The Western Washington Randomized Trial of Intracoronary Streptokinase in Acute Myocardial Infarction1985 · 455 citations
  2. 2Effect of Intravenous Streptokinase on Acute Myocardial Infarction1982 · 205 citations