Circulation, Vol 75, 980-987, Copyright © 1987 by American Heart Association
AJ Feiring, MR Johnson, JM Kioschos, PT Kirchner, ML Marcus and CW White
On the basis of animal studies, we postulated that the size of the
perfusion field (risk area) of an occluded coronary artery would be an
important determinant of outcome in patients with acute myocardial
infarction. To test this hypothesis, we measured size of the risk area in
27 patients with acute myocardial infarction by the intracoronary injection
of 99mTc-macroaggregated albumin and gated nuclear imaging. After injection
of the albumin spheres (5.3 +/- 1.4 hr after the onset of chest pain)
streptokinase was administered and in 16 of 27 patients (59%) effective
thrombolysis was achieved. Since none of the patients had evidence of a
prior acute myocardial infarction, the 3 day nuclear left ventricular
ejection fraction (LVEF) was considered an index of infarct size. Response
to thrombolysis was analyzed according to success or failure of reperfusion
and the size of the risk area (small risk area less than 25%, large risk
area greater than 25% of left ventricular surface area). Standard clinical
indexes correlated poorly with size of the risk area: electrocardiographic
variables (r = .37), left ventricular end-diastolic pressure (r = .23),
cardiac index (r = .55), and the LVEF obtained from a right anterior
oblique contrast ventriculogram (r = .31). The coronary vessel responsible
for the acute myocardial infarction significantly influenced size of the
risk area (left anterior descending, 38 +/- 5% [mean +/- SD] vs circumflex
or right coronary artery, 17 +/- 4%). However, knowledge of the site of
coronary occlusion within a vessel was not helpful in predicting the size
of the area at risk.(ABSTRACT TRUNCATED AT 250 WORDS)
ARTICLES
The importance of the determination of the myocardial area at risk in the evaluation of the outcome of acute myocardial infarction in patients
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