TY - JOUR
T1 - Prognosis of myocardial infarctions involving more than 40% of the left ventricle after acute reperfusion therapy
AU - McCallister, Ben D.
AU - Christian, Timothy F.
AU - Gersh, Bernard J.
AU - Gibbons, Raymond J.
PY - 1993/10
Y1 - 1993/10
N2 - 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 038±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.
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 038±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.
KW - Coronary heart disease
KW - Myocardial infarction
KW - Radionuclide imaging
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U2 - 10.1161/01.CIR.88.4.1470
DO - 10.1161/01.CIR.88.4.1470
M3 - Article
C2 - 8403294
AN - SCOPUS:0027482875
SN - 0009-7322
VL - 88
SP - 1470
EP - 1475
JO - Circulation
JF - Circulation
IS - 4
ER -