Myocardial viability in patients with Q wave myocardial infarction and no residual ischemia.
Key result
Percutaneous transluminal coronary angioplasty significantly improved mean coronary blood flow (33 vs 16 ml/min; p<0.05) and regional wall motion compared to conservative treatment in Q wave MI.
Why the study?
Does PTCA improve coronary flow and myocardial viability in asymptomatic patients with Q wave MI and no residual ischemia?
Population
15 asymptomatic patients with a Q wave myocardial infarction, no redistribution on stress 201Tl test, and…
Comparison
Percutaneous transluminal coronary artery… vs Conservative medical treatment
Design
RCT, randomized
Follow-up
2 months
Authors
Discussion
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Implication
Supports PTCA in asymptomatic Q-wave MI without ischemia; extends evidence of prolonged viability beyond symptomatic indications.
Key Points
- To determine whether viable myocardium persists in the infarct area and recovers function following angioplasty in asymptomatic patients with Q wave myocardial infarction and no residual ischemia.
- Randomized trial of 15 asymptomatic patients with Q wave myocardial infarction, single-vessel disease (>70% stenosis), persistent anterograde flow, and no redistribution on stress thallium-201 testing.
- Patients were allocated to percutaneous transluminal coronary angioplasty (PTCA, n=8) or conservative medical treatment (n=7) with follow-up at 2 months.
- Coronary blood flow in the infarct-related artery at 2 months was significantly higher in the PTCA arm (33 ± 6 mL/min) than in the conservative arm (16 ± 4 mL/min; p < 0.05).
- PTCA significantly increased postexercise thallium-201 uptake ratios (delta = +8.5 ± 2.3% vs +1.1 ± 2.2%; p < 0.05 between groups) and segmental wall motion (delta = +11.5 ± 2.2% vs +4.1 ± 1.4%; p < 0.05 between groups), which correlated with each other (r = 0.73, p = 0.002), though global ejection fraction changes did not differ significantly.
Study Design
Type
RCT (n=15)
Structured PICO
Does PTCA improve coronary flow and myocardial viability in asymptomatic patients with Q wave MI and no residual ischemia?
P
Population
15 asymptomatic patients with a Q wave myocardial infarction, no redistribution on stress 201Tl test, and single-vessel disease (greater than 70% stenosis) with persistent anterograde blood flow
I
Intervention
Percutaneous transluminal coronary artery angioplasty (PTCA)
C
Comparator
Conservative medical treatment
O
Outcome
Mean coronary blood flow measured by Doppler catheter in the infarct-related artery at 2 monthssurrogate
Main Result
Absolute Event Rate: 33% vs 16%
p-value: p=<0.05
Successful angioplasty of the stenotic infarct artery in patients with a Q wave MI and no residual ischemia improves coronary flow, thallium uptake, and regional wall motion, suggesting prolonged myocardial viability.
Cite This Study
Montalescot et al. (1992) conducted an RCT in Q wave myocardial infarction without residual ischemia (n=15). Percutaneous transluminal coronary artery angioplasty (PTCA) vs. Conservative medical treatment was evaluated on Mean coronary blood flow in the infarct-related artery (p=<0.05). Percutaneous transluminal coronary angioplasty significantly improved mean coronary blood flow (33 vs 16 ml/min; p<0.05) and regional wall motion compared to conservative treatment in Q wave MI.