Multivessel disease identified by coronary angiography in asymptomatic or mildly symptomatic patients post-first myocardial infarction is associated with a high rate of subsequent cardiac events.
Multivessel disease post-first MI signals higher event risk; hypothesis-generating for risk stratification but should not yet change practice.
The role of coronary arteriography in the asymptomatic or mildly symptomatic post first myocardial infarction patient is controversial. Thirty-one class 0-1 patients (Canadian Heart Association Grading System) underwent coronary arteriography within six months (mean 67 days) of their first myocardial infarction. Coronary arteriography revealed three-vessel disease in nine (29%), two-vessel disease in ten (32%), single-vessel disease in ten (32%), and normal coronary arteries in two (6%). No patient had left main disease, and two (6%) had left main equivalent disease. In 12 patients with single-vessel disease or normal coronary arteries there were no morbid events over a mean follow-up period of 26 months. In the 19 with multivessel disease, eight (40)% developed a cardiac event during a mean follow-up period of 11.4 months. These included one who elected to undergo immediate aortocoronary bypass surgery, two with unstable angina, three acute myocardial infarctions, and two deaths. Based on these data and review of the literature, a scheme is proposed for the subsequent evaluation and treatment of this patient group.
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Mautner et al. (1981) studied this question.