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Late reopening of an occluded infarct related artery improves left ventricular function and long term clinical outcome
  1. F Piscione,
  2. G Galasso,
  3. G De Luca,
  4. G Marrazzo,
  5. G Sarno,
  6. O Viola,
  7. D Accardo,
  8. M Chiariello
  1. Department of Cardiology, Federico II University, Naples, Italy
  1. Correspondence to:
    Dr F Piscione
    Via S Pansini, 5, 80131 Naples, Italy;


Objective: To assess effects on left ventricular (LV) function and on long term clinical outcome of late percutaneous transluminal coronary angioplasty (PTCA) of a chronically occluded infarct related artery.

Methods: 65 patients who underwent PTCA a mean (SD) of 6.0 (1.2) months after a previous myocardial infarction were divided in two groups according to dilated artery patency status after PTCA: group 1 (35 patients with TIMI (thrombolysis in myocardial infarction) grade 3 flow) and group 2 (30 patients with TIMI grade 0–2 flow). Echocardiography was performed at admission and at six months’ follow up. A three year follow up was conducted with major adverse cardiac events (MACE) as end points.

Results: At follow up, group 1 had improved global LV ejection fraction (48.7% v 43.6%, p < 0.001) and LV indexed end diastolic and end systolic volumes (75 v 86 ml/m2 and 40 v 53 ml/m2, respectively, p  =  0.011) compared with group 2. Kaplan-Meier analysis showed a higher incidence of cardiac death (p  =  0.02) and MACE (p < 0.0001) in group 2. TIMI 3 after PTCA was an independent predictor of event-free survival at follow up.

Conclusion: Late PTCA of a chronically occluded infarct related artery improves LV function, reduces cardiac death, and improves long term clinical outcome.

  • EDVi, end diastolic volume index
  • ESVi, end systolic volume index
  • IRA, infarct related artery
  • LV, left ventricular
  • LVEF, left ventricular ejection fraction
  • MACE, major adverse cardiac events
  • MI, myocardial infarction
  • PTCA, percutaneous transluminal coronary angioplasty
  • TIMI, thrombolysis in myocardial infarction
  • WMSI, wall motion score index
  • angioplasty
  • chronic total coronary occlusion
  • echocardiography
  • myocardial infarction
  • prognosis

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