Prognosis of myocardial infarctions involving more than 40% of the left ventricle after acute reperfusion therapy

B. D. McCallister, T. F. Christian, B. J. Gersh, Raymond J Gibbons

Research output: Contribution to journalArticle

16 Citations (Scopus)

Abstract

Background. Prior studies based on autopsy data suggest that infarction of more than 40% of the left ventricle necessitates cardiogenic shock and death. Methods and Results. Technetium-99m Sestamibi tomography was used prospectively to measure infarct size at discharge in 166 patients with acute myocardial infarction. Patients with previous myocardial infarction or revascularization were excluded from the trial. Sixteen patients were identified with final infarct sizes >40% of the left ventricle despite acute reperfusion therapy. These 16 patients (13 men) had a mean age of 63±10 years; 44% had a previous history of angina. Ten patients had emergent coronary angioplasty only (mean time to percutaneous transluminal coronary angioplasty [PTCA], 6.0±3.0 hours); 6 had thrombolysis (mean time to tissue plasminogen activator, 4.0±1.5 hours), of which 2 had rescue PTCA (5 and 3 hours from onset of pain). Of 15 patients who had angiograms after therapy, 15 had open infarct-related arteries. The left anterior descending artery was the infarct-related artery in 14 (9 proximal and 5 distal lesions). Half the patients had only single-vessel disease. Infarct size measured 50±7% of the left ventricle (range, 42% to 68%). Ejection fraction by radionuclide angiogram was 0.33±0.09 and 0.38±0.07 at discharge and 6 weeks, respectively. Hospital complications included shock (1 patient), pulmonary edema (2), angina (3), symptomatic nonsustained ventricular tachycardia (1), transient complete heart block (2), and transient bifascicular block (1). At follow-up (13±9 months), the patient with shock had died, but the remaining 15 patients were asymptomatic (1 had late PTCA for angina). Conclusions. In the interventional and thrombolytic era, patients with large residual myocardial infarctions can survive without heart failure.

Original languageEnglish (US)
Pages (from-to)1470-1475
Number of pages6
JournalCirculation
Volume88
Issue number4 I
StatePublished - 1993

Fingerprint

Reperfusion
Heart Ventricles
Myocardial Infarction
Coronary Balloon Angioplasty
Therapeutics
Arteries
Shock
Angiography
Technetium Tc 99m Sestamibi
Myocardial Revascularization
Heart Block
Cardiogenic Shock
Tissue Plasminogen Activator
Pulmonary Edema
Ventricular Tachycardia
Angioplasty
Radioisotopes
Infarction
Autopsy
Heart Failure

Keywords

  • coronary heart disease
  • myocardial infarction
  • radionuclide imaging

ASJC Scopus subject areas

  • Physiology
  • Cardiology and Cardiovascular Medicine

Cite this

Prognosis of myocardial infarctions involving more than 40% of the left ventricle after acute reperfusion therapy. / McCallister, B. D.; Christian, T. F.; Gersh, B. J.; Gibbons, Raymond J.

In: Circulation, Vol. 88, No. 4 I, 1993, p. 1470-1475.

Research output: Contribution to journalArticle

McCallister, B. D. ; Christian, T. F. ; Gersh, B. J. ; Gibbons, Raymond J. / Prognosis of myocardial infarctions involving more than 40% of the left ventricle after acute reperfusion therapy. In: Circulation. 1993 ; Vol. 88, No. 4 I. pp. 1470-1475.
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abstract = "Background. Prior studies based on autopsy data suggest that infarction of more than 40{\%} of the left ventricle necessitates cardiogenic shock and death. Methods and Results. Technetium-99m Sestamibi tomography was used prospectively to measure infarct size at discharge in 166 patients with acute myocardial infarction. Patients with previous myocardial infarction or revascularization were excluded from the trial. Sixteen patients were identified with final infarct sizes >40{\%} of the left ventricle despite acute reperfusion therapy. These 16 patients (13 men) had a mean age of 63±10 years; 44{\%} had a previous history of angina. Ten patients had emergent coronary angioplasty only (mean time to percutaneous transluminal coronary angioplasty [PTCA], 6.0±3.0 hours); 6 had thrombolysis (mean time to tissue plasminogen activator, 4.0±1.5 hours), of which 2 had rescue PTCA (5 and 3 hours from onset of pain). Of 15 patients who had angiograms after therapy, 15 had open infarct-related arteries. The left anterior descending artery was the infarct-related artery in 14 (9 proximal and 5 distal lesions). Half the patients had only single-vessel disease. Infarct size measured 50±7{\%} of the left ventricle (range, 42{\%} to 68{\%}). Ejection fraction by radionuclide angiogram was 0.33±0.09 and 0.38±0.07 at discharge and 6 weeks, respectively. Hospital complications included shock (1 patient), pulmonary edema (2), angina (3), symptomatic nonsustained ventricular tachycardia (1), transient complete heart block (2), and transient bifascicular block (1). At follow-up (13±9 months), the patient with shock had died, but the remaining 15 patients were asymptomatic (1 had late PTCA for angina). Conclusions. In the interventional and thrombolytic era, patients with large residual myocardial infarctions can survive without heart failure.",
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AB - Background. Prior studies based on autopsy data suggest that infarction of more than 40% of the left ventricle necessitates cardiogenic shock and death. Methods and Results. Technetium-99m Sestamibi tomography was used prospectively to measure infarct size at discharge in 166 patients with acute myocardial infarction. Patients with previous myocardial infarction or revascularization were excluded from the trial. Sixteen patients were identified with final infarct sizes >40% of the left ventricle despite acute reperfusion therapy. These 16 patients (13 men) had a mean age of 63±10 years; 44% had a previous history of angina. Ten patients had emergent coronary angioplasty only (mean time to percutaneous transluminal coronary angioplasty [PTCA], 6.0±3.0 hours); 6 had thrombolysis (mean time to tissue plasminogen activator, 4.0±1.5 hours), of which 2 had rescue PTCA (5 and 3 hours from onset of pain). Of 15 patients who had angiograms after therapy, 15 had open infarct-related arteries. The left anterior descending artery was the infarct-related artery in 14 (9 proximal and 5 distal lesions). Half the patients had only single-vessel disease. Infarct size measured 50±7% of the left ventricle (range, 42% to 68%). Ejection fraction by radionuclide angiogram was 0.33±0.09 and 0.38±0.07 at discharge and 6 weeks, respectively. Hospital complications included shock (1 patient), pulmonary edema (2), angina (3), symptomatic nonsustained ventricular tachycardia (1), transient complete heart block (2), and transient bifascicular block (1). At follow-up (13±9 months), the patient with shock had died, but the remaining 15 patients were asymptomatic (1 had late PTCA for angina). Conclusions. In the interventional and thrombolytic era, patients with large residual myocardial infarctions can survive without heart failure.

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