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Prevalence and prognosis after a first nontransmural myocardial infarction
Insights
Nontransmural myocardial infarction (MI) affects younger patients with better heart function and less severe coronary artery disease. Long-term survival and new cardiac events are similar to transmural MI, suggesting less aggressive management may be appropriate.
Area of Science:
- Cardiology
- Cardiovascular Medicine
- Clinical Research
Background:
- Nontransmural myocardial infarction (MI) represents a subset of acute coronary syndromes.
- Understanding the characteristics and outcomes of nontransmural MI is crucial for clinical management.
- Previous studies have varied in their assessment of nontransmural MI prognosis.
Purpose of the Study:
- To prospectively assess the prevalence, prognosis, and coronary anatomy in patients with nontransmural MI.
- To compare clinical characteristics and long-term outcomes of nontransmural MI with transmural MI.
- To determine if more aggressive management is warranted for nontransmural MI.
Main Methods:
- Prospective study of 458 men admitted with first MI.
- Cardiac catheterization performed in survivors within 1 month.
- Mean follow-up of 33 months (range 5-72 months).
Main Results:
- Nontransmural MI diagnosed in 6% of patients.
- Nontransmural MI patients were younger, had lower peak creatine kinase, and better ejection fraction.
- Fewer affected arteries and lower prevalence of total occlusion in nontransmural MI.
- Similar mortality and long-term survival rates between nontransmural and transmural MI groups.
- Comparable rates of new nonfatal coronary events in both groups.
Conclusions:
- Nontransmural MI is associated with favorable clinical and angiographic features.
- Long-term prognosis and risk of recurrent events are similar to transmural MI.
- In the absence of symptoms, aggressive management beyond standard care may not be necessary for nontransmural MI.
Abstract:
Prevalence, prognosis, and coronary anatomy associated with nontransmural myocardial infarction (MI) were prospectively assessed in 458 consecutive men admitted to our coronary care unit with a first MI. Cardiac catheterization was performed in 402 of the 436 survivors within 1 month of the acute event. Mean follow-up was 33 months (range 5 to 72). Nontransmural MI was diagnosed in 28 patients (6%). These patients were younger (46 +/- 10 versus 51 +/- 7 years, p less than 0.001) and had lower peak creatine kinase values (601 +/- 319 versus 1,141 +/- 923 U, p less than 0.01) and better ejection fraction (63 +/- 8 versus 46 +/- 14, p less than 0.001) than did their counterparts. Survivors of nontransmural MI also had fewer affected arteries (p less than 0.001) and a lower prevalence of total or subtotal occlusion (greater than 90%) in the involved artery (p less than 0.01). Mortality in the acute phase and long-term survival at 4 years (Kaplan-Meier) in patients with nontransmural MI (94%) were similar to those in patients with transmural MI (90%). The occurrence of new nonfatal coronary events was also similar in both groups of MI survivors. Thus, in the absence of symptoms, more aggressive management to improve survival does not seem warranted after nontransmural MI.