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[Hemodynamic and coronarographic evaluation for identification of high risk patients following myocardial infarction]
Insights
Early cardiac catheterization after myocardial infarction identifies high-risk patients. Left ventricular function and triple-vessel disease predict mortality, especially within the first year post-infarction.
Area of Science:
- Cardiology
- Clinical Medicine
- Diagnostic Imaging
Background:
- High early mortality rates impact prognosis for myocardial infarction survivors.
- Identifying high-risk patients early is crucial for post-infarction management.
Purpose of the Study:
- To evaluate the prognostic value of early cardiac catheterization and coronary angiography.
- To identify patients at high risk of mortality after myocardial infarction.
Main Methods:
- 200 patients surviving myocardial infarction underwent hemodynamic and coronary angiography (average 26 days post-infarction).
- Follow-up averaged 43.2 months to assess overall mortality.
- Analysis included left ventricular function (ejection fraction) and coronary artery disease extent.
Main Results:
- Overall mortality was 13.5%, with sudden death being the most common cause (52%).
- Pathological left ventricular function and multivessel (93%) or triple-vessel disease (63%) were linked to higher mortality.
- Ejection fraction <30% showed 38.5% mortality in the first year; triple-vessel disease had 13% first-year mortality.
Conclusions:
- Early cardiac catheterization and coronary angiography are valuable for risk stratification post-myocardial infarction.
- Left ventricular ejection fraction and triple-vessel disease are significant predictors of early mortality.
- Patients with normal left ventricular function and single-vessel disease have an excellent long-term prognosis.
Abstract:
The prognosis of patients surviving myocardial infarction is influenced by a high early mortality rate. The aim of this study was to assess the prognostic value of cardiac catheterisation and coronary angiography performed early after infarction to identify patients at high risk. Two hundred patients including 10 women with an average age of 49.1 +/- 8.6 years surviving (greater than 1 month) primary myocardial infarction underwent haemodynamic and coronary angiographic investigations on average 26 days after the onset of infarction (26 +/- 17 days, range 1 to 90 days). All patients were followed up for average period of 43.2 +/- 13.3 months. The overall mortality rate was 13.5% (27/200). The commonest cause of demise was sudden death: 52% (14/27). Most patients died within the first year of infarction (11/27). Indices of left ventricular function (left ventricular end diastolic pressure and ejection fraction) were significantly more pathological in the patients who died. Similarly, there were many more patients with multivessel (93%) and triple vessel disease (63%) in this sub group (p less than 0,001). Analysis of actuarial survival with respect to ejection fraction demonstrated the prognostic importance of this factor, especially during the first year: 38.5% mortality in patients with ejection fractions below 30%. Triple vessel disease was associated with 13% mortality in the first year. When these two factors were combined, the risk of death in the first year was 50%, so identifying a very high risk subgroup. On the other hand, no deaths were observed in patients with a single coronary lesion and normal left ventricular function (ejection fraction greater than 50%) during 72 months follow-up.(ABSTRACT TRUNCATED AT 250 WORDS)