The open artery: Beyond myocardial salvage

doi:10.1016/0002-9149(93)90112-P

The American Journal of Cardiology

Volume 72, Issue 19, 16 December 1993, Pages G85-G90

https://doi.org/10.1016/0002-9149(93)90112-P Get rights and content

Abstract

Despite the potential limitations, the available data suggest the importance of the open artery as a marker of survival following infarction. Perhaps the most important, although as yet unanswered, question is when is it too late to reopen an artery? Further, is reperfusion by interventional techniques preferable to reperfusion by lytic therapy alone? Although a reduction in mortality has not been demonstrated for thrombolysis beyond 12 hours (other than the Second International Study of infarct Survival, ISIS-2), improvements in ventricular function (which might translate into a survival benefit) have been demonstrated even for very delayed reperfusion. it is hoped that future work will allow us to answer better when such therapy might be preferable.

References (47)

JE Dalen et al.
Six and twelve month follow-up of the Phase I thrombolysis in myocardial infarction (TIMI) trial
Am J Cardiol
(1988)
T Meinertz et al.
The German multicenter trial of aniosoylated plasminogen streptokinase activator complex versus heparin for acute myocardial infarction
Am J Cardiol
(1988)
RM Califf et al.
From myocardial salvage to patient salvage in acute myocardial infarction: the role of reperfusion therapy
J Am Coll Cardiol
(1989)
RG Cigarroa et al.
Prognosis after acute myocardial infarction in patients with and without residual anterograde coronary blood flow
Am J Cardiol
(1989)
GF Mitchell et al.
Left ventricular remodeling in the year after first anterior myocardial infarction: a quantitative analysis of contractile segment lengths and ventricular shape
J Am Coll Cardiol
(1992)
RW Jeremy et al.
Infarct artery perfusion and changes in left ventricular volume in the month after acute myocardial infarction
J Am Coll Cardiol
(1987)
CJ Lavie et al.
Prevention of late ventricular dilatation after acute myocardial infarction by successful thrombolytic reperfusion
Am J Cardiol
(1990)
SE Warren et al.
Time course of left ventricular dilatation after myocardial infarction: influence of infarct-related artery and success of coronary thrombolysis
J Am Coll Cardiol
(1988)
P Marino et al.
Effect of streptokinase on left ventricular modeling and function after myocardial infarction: the GISSI trial
J Am Coll Cardiol
(1989)
WH Leung et al.
Effects of severity of the residual stenosis of the infarct-related coronary artery on left ventricular dilation and function after myocardial infarction
J Am Coll Cardiol
(1992)

T Force et al.

Acute reduction in functional infarct expansion with late coronary reperfusion: assessment with quantitative two-dimensional echocardiography

J Am Coll Cardiol

(1988)

SL Hale et al.

Left ventricular topographic alterations in the completely healed rat infact caused by early and late coronary artery reperfusion

Am Heart J

(1988)

RA Kloner

Coronary angioplasty: a treatment option for left ventricular remodeling after myocardial infarction?

J Am Coll Cardiol

(1992)

IE Kersschot et al.

Effects of early reperfusion in acute myocardial infarction on arrhythmias induced by programmed stimulation: a prospective, randomized study

J Am Coll Cardiol

(1986)

PT Sager et al.

Electrophysiologic effects of thrombolytic therapy in patients with a transmural anterior myocardial infarction complicated by left ventricular aneurysm formation

J Am Coll Cardiol

(1988)

PJ Vatterott et al.

Late potentials on signal averaged electrocardiograms and patency of the infarct related artery in survivors of acute myocardial infarction

J Am Coll Cardiol

(1991)

JD Boehrer et al.

Effects of coronary angioplasty on late potentials one to two weeks after acute myocardial infarction

Am J Cardiol

(1992)

JA Ambrose et al.

Angiographic progression of coronary artery disease and the development of myocardial infarction

J Am Coll Cardiol

(1988)

L Karagounis et al.

Does thrombolysis in myocardial infarction (TIMI) perfusion grade 2 represent a mostly patent artery or a mostly occluded artery? Enzymatic and electrocardiographic evidence from the team-2 study

J Am Coll Cardiol

(1992)

FH Sheehan et al.

Early recovery of left ventricular function after thrombolytic therapy for acute myocardial infarction: an important determinant for survival

J Am Coll Cardiol

(1988)

KA Reimer et al.

The wavefront phenomenon of ischemic cell death

Circulation

(1977)

JS Hockman et al.

Limitation of myocardial infarct expansion by reperfusion independent of myocardial salvage

Circulation

(1987)

G Koren et al.

Prevention of myocardial ischemia by early treatment with intravenous streptokinase

N Engl J Med

(1985)

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Prognostic factors of the acute myocardial infarction treated with fibrinolytics
1999, Revista Espanola de Cardiologia
Objetivos. Existe cierta controversia sobre la validez de la ergometría en la evaluación de pacientes que han sufrido un infarto agudo de miocardio tratado con fibrinolíticos. Además, la influencia en el pronóstico de la permeabilidad de la arteria responsable del infarto no ha sido establecida clara-mente. Nuestros objetivos fueron determinar la vigencia de la ergometría y la influencia de la permeabilidad de la arteria en el pronóstico tras un infarto.
Material y métodos. Se estudiaron 99 pacientes con un primer infarto tratado con fibrinolíticos y no complicado. Se realizaron ergometría y cateterismo cardíaco en el primer mes. Se hizo un seguimiento de los pacientes durante 2 años, regis-trándose los eventos mayores (reinfarto o fallecimiento) y menores (angina clase II o superior, disnea grado II o superior o taquicardia ventricular sostenida).
Resultados. En el análisis multivariante median-te regresión de Cox se observó como predictor independiente de eventos mayores: no alcanzar 4 METS en la ergometría (RR = 5,6; IC del 95%, 1,68–19). Las variables predictoras de eventos menores fueron: enfermedad multivaso (RR = 3,36; IC del 95%, 1,56–7,24), localización anterior del infarto (RR = 3,15; IC del 95%, 1,3–7,6), ergometría anormal (RR = 2,98; IC del 95%, 1,46–6,09) y fracción de eyección £ 40% (RR = 2,48; IC del 95%, 1,07–5,74). La oclusión de la arteria responsable del infarto no predijo la incidencia de eventos.
Conclusiones. La ergometría es válida para establecer el pronóstico en los pacientes tratados con trombólisis. La oclusión de la arteria relacionada con el infarto no resulta predictora de eventos tras dos años de seguimiento.
Background. The usefulness of the exercise test in evaluating patients with an acute myocardial infarction treated with fibrinolytics is controversial. On the other hand, the pronostic value of a patent infarct-related artery has not been clearly established. The objectives of this study were to assess the validity of the exercise test and to study the prognostic value of the artery patency after a myocar-dial infarction.
Material and methods. We studied 99 patients with a myocardial infarction treated with fibrinolytics, non-complicated. An exercise test and a cardiac catheterization were performed in the first month. The patients were followed-up for 2 years, recording the major cardiac events (death and reinfarction) and the minor events (angina class (II, left cardiac failure class (II or mantained ventricular tachicardia).
Results. On multivariate analysis with Cox regression, a workload < 4 METS at the exercise test was the only independent prognostic factor of major events (RR 5.6; CI 95% 1.68 -19). The independent prognostic factors of minor events were: multivessel disease (RR 3.36; CI 95% 1.56–7.24), anterior infarction (RR 3.15; CI 95% 1.3–7.6), abnormal exercise test (RR 2.98; CI 95% 1.46–6.09) and ejection fraction £ 40% (RR 2.48; CI 95% 1.07–5.74). The patency of the infarct-related artery was not a predictor of events.
Conclusions. The exercise test is useful in predicting the prognosis in patients treated with fibrinolytics. An occluded infarct-related artery was not an independent predictor of cardiac events in 2 years of follow-up.
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