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Late revascularization reduces mortality in survivors of myocardial infarction
L D Hillis1, J E Cigarroa, R A Lange
1Department of Internal Medicine (Cardiovascular Division), University of Texas Southwestern Medical Center, Dallas, Texas 75235-9047, USA.
Insights
Restoring blood flow in the infarct-related artery after myocardial infarction improves survival, even weeks later. This enhanced blood flow reduces the risk of fatal ventricular arrhythmias.
Area of Science:
- Cardiology
- Cardiovascular Research
- Clinical Medicine
Background:
- Survivors of acute myocardial infarction (MI) may experience improved prognosis through mechanisms beyond left ventricular systolic performance.
- Antegrade flow restoration in the infarct-related artery, even late after MI, can significantly impact long-term survival.
Purpose of the Study:
- To investigate the prognostic value of antegrade flow in the infarct-related coronary artery in MI survivors.
- To determine if mechanical restoration of flow improves long-term survival and reduces electrical instability.
Main Methods:
- Retrospective analysis of survival data in myocardial infarction survivors.
- Evaluation of the impact of spontaneous or mechanically restored antegrade flow on long-term outcomes.
- Assessment of the effect of late flow restoration on the electrical stability of the infarct border zone.
Main Results:
- Long-term survival is substantially better in MI survivors with antegrade flow compared to those without.
- Mechanical restoration of flow (angioplasty, bypass grafting) markedly improves long-term survival.
- Late restoration of antegrade flow reduces electrical instability in the infarct border zone, decreasing ventricular tachyarrhythmias and sudden death.
Conclusions:
- Restoration of antegrade flow in the infarct-related artery is a critical determinant of long-term survival after acute myocardial infarction.
- The benefits of flow restoration extend beyond hemodynamic improvements, impacting arrhythmogenesis.
- Late intervention to restore coronary artery patency can salvage myocardium and prevent fatal arrhythmias.
Abstract:
In survivors of acute myocardial infarction, the restoration of antegrade flow in the infarct-related coronary artery may improve prognosis by a mechanism that is independent of its influence on left ventricular systolic performance. Furthermore, survival may be improved even when antegrade flow is restored days or even weeks after the acute event. In several retrospective studies of survivors of infarction, we and others have shown a) that long-term survival is substantially better in those with-as opposed to those without-antegrade flow in the infarct-related coronary artery, and b) that the mechanical restoration of flow in an occluded infarct-related artery (accomplished with balloon angioplasty or bypass grafting) markedly improves long-term survival. The late restoration of antegrade flow in the infarct-related artery appears to render the so-called border zone of infarction less electrically unstable, thereby reducing the likelihood of ventricular tachyarrhythmias and sudden death.
