Circulation, Vol 90, 1747-1756, Copyright © 1994 by American Heart Association
SH Hohnloser, P Franck, T Klingenheben, M Zabel and H Just
BACKGROUND: Successful reperfusion of the infarct-related artery in
patients with acute myocardial infarction has been shown to reduce in-
hospital as well as 1-year mortality. Besides the thrombolysis-induced
myocardial salvage, there is increasing evidence that an open infarct-
related artery results in increased electrical stability of the heart and
that this effect is at least in part responsible for the favorable
long-term outcome of these patients. The exact incidence of arrhythmic
events during the first year after myocardial infarction and the predictive
value of different risk factors for these complications, however, have not
been determined in patients in the thrombolytic era. METHODS AND RESULTS: A
total of 173 patients with acute myocardial infarction, 51% treated with
thrombolysis, were prospectively entered into the study. At the time of
hospital discharge, signal-averaged ECG, Holter monitoring, radionuclide
angiography, coronary angiography, and levocardiography were performed in
all patients. An open infarct- related artery was documented in 136
patients. The overall incidence of late potentials was 24% (41 patients).
By multivariate analysis, an occluded infarct-related artery (P = .04) and
the presence of regional wall motion abnormalities (P = .02) were the
strongest independent predictors for the development of a late potential.
Residual ischemia was treated by either percutaneous transluminal coronary
angioplasty or surgery in 86 of 173 patients (50%). Seventy percent of the
patients received beta-blocker therapy. During a mean follow-up of 12 +/- 5
months, 7 patients died suddenly or had ventricular fibrillation
documented, while only 2 developed sustained monomorphic ventricular
tachycardia. Overall 1-year mortality was 4.1%. Multivariate analysis
revealed only an occluded infarct-related artery as an independent
predictor of arrhythmic complications (P = .017). CONCLUSIONS: In patients
with acute myocardial infarction treated according to contemporary
therapeutic guidelines, with a large proportion of individuals undergoing
coronary artery revascularization, a low incidence of arrhythmic events,
particularly of ventricular tachycardia, was observed in the first year
after the index infarction. The presence or absence of an open
infarct-related artery was the strongest independent predictor of these
events, whereas other traditional risk factors, such as late potentials,
were less helpful in identifying patients prone to sudden death. These
findings emphasize the importance of the open artery hypothesis in patients
recovering from acute myocardial infarction.
ARTICLES
Open infarct artery, late potentials, and other prognostic factors in patients after acute myocardial infarction in the thrombolytic era. A prospective trial
University Hospital, Department of Cardiology, Freiburg, Germany.
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