Reocclusion of the infarct-related artery within 3 months of successful thrombolysis was associated with significantly larger end-diastolic volume index at 5 years (99 vs 76 mL/m2; P=0.007).
Cohort (n=56)
Does reocclusion of the infarct-related artery after successful thrombolysis worsen long-term left ventricular size and function in patients with first anterior myocardial infarction?
Reocclusion of the infarct-related artery within 3 months of successful thrombolysis is associated with long-term left ventricular dilatation and impaired functional recovery.
p-value: p=0.007
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. METHODS AND 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.
Nijland et al. (1997) conducted a cohort in First anterior myocardial infarction (n=56). Reocclusion of the infarct-related artery vs. No reocclusion was evaluated on Left ventricular size and function (including end-diastolic volume index) (p=0.007). Reocclusion of the infarct-related artery within 3 months of successful thrombolysis was associated with significantly larger end-diastolic volume index at 5 years (99 vs 76 mL/m2; P=0.007).