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[So-called rudimentary or nontransmural myocardial infarction. Coronary lesions, course and prognosis]
Insights
This study on non-transmural myocardial infarction found that isolated severe LAD disease was common in Group A, while multivessel disease predominated in Group B. Collateral circulation was observed in nearly half of Group A patients.
Area of Science:
- Cardiology
- Internal Medicine
- Medical Research
Background:
- Non-transmural myocardial infarction (MI) diagnosis relies on specific clinical and biochemical markers.
- Patients were categorized into two groups based on distinct electrocardiogram (ECG) changes: 'rudimentary' infarction (Group A) and subendocardial infarct (Group B).
Purpose of the Study:
- To compare angiographic findings and clinical outcomes in patients with non-transmural myocardial infarction.
- To investigate the correlation between ECG patterns, coronary artery disease severity, and prognosis.
Main Methods:
- Eighty patients with non-transmural MI underwent selective coronary angiography and left ventriculography.
- Angiographic data were compared with control groups of inferior wall and transmural anterior MI.
- Follow-up analysis included mortality, recurrent MI, unstable angina, and cardiac failure.
Main Results:
- Group A showed a high incidence of isolated, severe Left Anterior Descending (LAD) artery disease (59.2%).
- Multivessel disease was more prevalent in Group B (78.4%).
- Collateral circulation to the LAD was present in 42% of Group A patients.
Conclusions:
- Specific ECG findings in non-transmural MI correlate with distinct coronary artery disease patterns.
- LAD disease is a significant factor in 'rudimentary' infarction, while multivessel disease characterizes subendocardial infarcts.
- Further investigation into the prognostic implications of these findings is warranted.
Abstract:
Eighty patients admitted to hospital between 1975 and 1980 for "non-transmural" myocardial infarction (72 men, 8 women, mean age 56 +/- 9 years) were studied. The diagnosis was based on a severe attack of pain of over 30 minutes duration, increased serum cardiac enzyme levels (CKMB greater than 24 U; SGOT greater than 60 U), pyrexia and signs of inflammation. The patients were divided into two groups according to their ECG changes: Group A: "rudimentary" infarction with prolonged T wave inversion from V1 to V5, narrow transient Q waves and reduction of R wave amplitude in the corresponding leads; Group B: persistant prolonged, intercritical ST depression greater than 2.5 mm (subendocardial infarct). All patients underwent selective coronary angiography and left ventriculography in the RAO projection within 15 days of admission. The angiographic data (coronary score, ejection fraction, alinetic perimeter) were compared to those of 2 randomly chosen control groups: Group C: 30 inferior wall infarcts with coronary angiography and regularly followed-up; Group D: 30 transmural anterior infarcts with coronary angiography, regularly followed-up. Four factors were analysed during follow-up: the incidence of death after discharge from hospital, transmural infarction, unstable angina and cardiac failure. All patients were treated medically (nitrate derivatives, betablockers, calcium antagonists). Sixteen patients in Group A (p less than 0,025) were operated and excluded from the prognostic study. The angiographic data showed a high incidence of isolated, severe LAD disease in Group A (59.2% of cases) and that multivessel disease was commoner in Group B (78.4%). A collateral circulation revascularising the LAD was observed in 42% of patients in Group A. (ABSTRACT TRUNCATED AT 250 WORDS)