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Circulation, Vol 86, 47-55, Copyright © 1992 by American Heart Association
G Montalescot, M Faraggi, G Drobinski, O Messian, J Evans, Y Grosgogeat and D Thomas
BACKGROUND. Coronary revascularization in patients with persistent angina
after myocardial infarction reduces the incidence of recurrent angina
pectoris and myocardial infarction and improves left ventricular function.
The results of revascularization after a Q wave myocardial infarction when
there is no residual ischemia may depend on myocardial viability. METHODS
AND RESULTS. To determine whether there was viable myocardium in the
infarct area in the absence of clinical and scintigraphic evidence of
myocardial ischemia, 15 asymptomatic patients with a Q wave myocardial
infarction, no redistribution on stress 201Tl test, and single-vessel
disease (greater than 70% stenosis) with persistent anterograde blood flow
were randomized to percutaneous transluminal coronary artery angioplasty
(PTCA) or conservative medical treatment. After 2 months of follow-up, mean
coronary blood flow measured by Doppler catheter in the infarct-related
artery was higher in the PTCA treatment group (33 +/- 6 ml/min, n = 8) than
in the conservative treatment group (16 +/- 4 ml/min, n = 7; p less than
0.05 between groups). The 201Tl pathological-to-normal ratios measured on
postexercise images did not change in patients treated conservatively
during the follow-up period (delta = +1.1 +/- 2.2%; NS from baseline) but
increased significantly in patients treated by PTCA (delta = +8.5 +/- 2.3%;
p less than 0.01 from baseline; p less than 0.05 between groups). Segmental
wall motion improved on left ventricular angiography 2 months after PTCA
(delta = +11.5 +/- 2.2%; p less than 0.001 from baseline) significantly
more than in the conservative treatment group (delta = +4.1 +/- 1.4%; p
less than 0.05 between both groups). Improvements of 201Tl ratios and
segmental wall motion indexes correlated significantly (r = 0.73, p =
0.002). The mild improvement of global left ventricular ejection fraction
measured in the PTCA treatment group did not differ significantly from
changes in the conservative treatment group. CONCLUSIONS. Successful
angioplasty of the stenotic infarct artery in patients with a Q wave
myocardial infarction and no residual ischemia improved coronary flow,
201Tl uptake in the infarct area, and regional wall motion. Therefore,
myocardial viability may last several weeks, as long as residual blood flow
persists in the infarct-related artery. Optimal assessment of viability by
imaging techniques should identify patients who are most likely to benefit
from revascularization.
ARTICLES
Myocardial viability in patients with Q wave myocardial infarction and no residual ischemia
Service de Cardiologie, Centre Hospitalier Universitaire Pitie- Salpetriere, Paris, France.
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