The effect of early postinfarction revascularization of asymptomatic patients on left ventricular remodeling
G Dangas1, J A Ambrose, S K Sharma
1Zena and Michael A. Wiener Cardiovascular Institute, Mount Sinai School of Medicine, New York, USA.
Insights
Early revascularization benefits asymptomatic patients after Q-wave myocardial infarction. Restoring artery patency, especially in totally occluded infarct-related arteries (IRAs), reduces adverse left ventricular remodeling and improves function.
Area of Science:
- Cardiology
- Cardiovascular Medicine
- Interventional Cardiology
Background:
- Patients with angina post-Q-wave myocardial infarction (MI) benefit from revascularization.
- The impact of revascularization on asymptomatic patients, particularly those with totally occluded infarct-related arteries (IRAs), remains unclear.
Purpose of the Study:
- To assess the effect of early revascularization on left ventricular (LV) remodeling in asymptomatic patients post-MI.
- To compare LV remodeling outcomes between patients with totally occluded IRAs versus patent IRAs.
Main Methods:
- Prospective study of 31 asymptomatic patients post-Q-wave MI undergoing early elective revascularization.
- Patients were divided into two groups: totally occluded IRA (Group I) and patent IRA (Group II).
- Echocardiography (resting and dobutamine stress) was used to assess LV volumes, ejection fraction, and myocardial viability at baseline and 8-week follow-up.
Main Results:
- Group I (totally occluded IRA) showed a significant decrease in LV end-systolic volume index (ESVI) and end-diastolic volume index, with an increase in ejection fraction.
- Group II (patent IRA) exhibited an increase in LV ESVI and end-diastolic volume index, with no significant change in ejection fraction.
- These differences in LV remodeling were statistically significant between the groups (P=0.006 for ESVI, P=0.02 for end-diastolic volume index, P=0.04 for ejection fraction).
Conclusions:
- Early elective revascularization is associated with less adverse LV remodeling in asymptomatic patients with a totally occluded IRA compared to those with a patent IRA post-MI.
- Restoring IRA patency after Q-wave MI appears beneficial for LV remodeling, even in asymptomatic individuals.
- These findings support revascularization for asymptomatic patients to mitigate deleterious LV remodeling.
Background:
Patients with angina after a Q-wave myocardial infarction benefit from elective revascularization, but it is not known whether asymptomatic patients, including those with a totally occluded infarct-related artery, improve after revascularization.
Objective:
To determine the effect of early postinfarction revascularization of asymptomatic patients on left ventricular remodeling.
Methods:
We prospectively studied 31 consecutive asymptomatic patients (aged 57 +/- 2 years, 24 with anterior infarcts) after Q-wave myocardial infarction with > or = 70% stenosis of the infarct-related artery (IRA) who underwent early elective revascularization (days 4-10 after myocardial infarction). Group I consisted in patients with a totally occluded IRA (n = 10), and group II consisted in patients with a patent, though stenosed, IRA (n = 21). Resting echocardiography and low-dose dobutamine echocardiography were performed at baseline (day 3 +/- 1), and rest echocardiography was repeated after an 8-week follow-up. Significant myocardial viability was defined as > or = 2 wall segments improved (in a 16-segment model of left ventricle) versus baseline, and significant functional recovery as > or = 2 segments improved versus baseline on follow-up examination. Left ventricular end-systolic volume indices (ESVI) and end-diastolic volume indices and ejection fractions were measured by using a modified version of Simpson's rule (using apical two-chamber and four-chamber views).
Results:
The left ventricular ESVI of patients in group I had decreased by 4.2 +/- 1.9 ml/m2, whereas for patients in group II the left ventricular ESVI had increased by 4.2 +/- 1.7 ml/m2 (P = 0.006). Similarly, the left ventricular end-diastolic volume index had decreased by 0.7 +/- 2.4 ml/m2 versus baseline at follow-up for patients in group I and increased by 7.8 +/- 2.1 ml/m2 for patients in group II (P = 0.02). The left ventricular ejection fraction increased by 7.3 +/- 3% for patients in group I and decreased by 0.4 +/- 2% for patients in group II (P = 0.04).
Conclusion:
There is less global left ventricular remodeling, a potentially deleterious process, after elective revascularization early after Q-wave myocardial infarction in asymptomatic patients who had had a totally occluded IRA before revascularization than there is in patients who had already had a patent, though stenosed, IRA before revascularization. These results suggest that restoration of patency of IRA after a Q-wave myocardial infarction is beneficial even for asymptomatic patients.
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