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Early versus late congestive heart failure after initially uncomplicated anterior wall acute myocardial infarction
J C Lystash1, R S Gibson, D D Watson
1Department of Medicine, University of Virginia Health Sciences Center, Charlottesville 22908, USA.
Insights
Predicting congestive heart failure (CHF) after myocardial infarction is crucial. Early CHF is linked to higher creatine kinase, lower ejection fraction, and persistent thallium defects, unlike late CHF.
Area of Science:
- Cardiology
- Internal Medicine
- Medical Research
Background:
- Anterior wall acute myocardial infarction (MI) can lead to congestive heart failure (CHF).
- Identifying factors predicting early versus late CHF post-MI is clinically significant for patient management.
Purpose of the Study:
- To determine the incidence of early (<3 months) and late (>3 months) CHF after anterior wall MI.
- To identify clinical, noninvasive, and angiographic predictors differentiating early from late CHF.
Main Methods:
- Prospective study of 94 patients (<65 years) post-anterior wall MI.
- Utilized predischarge tests: exercise thallium-201 scintigraphy, radionuclide angiography, and coronary arteriography.
- Follow-up for a mean of 49 months to assess CHF development.
Main Results:
- 10 of 68 medically managed patients developed early CHF, and 10 developed late CHF.
- Early CHF patients had higher peak creatine kinase, lower LV ejection fraction, more persistent thallium defects, and less multivessel disease.
- Late CHF was more often associated with recurrent infarction; bypass surgery patients showed outcomes similar to late CHF.
Conclusions:
- Distinct clinical and imaging profiles differentiate early from late CHF post-MI.
- Left ventricular function and myocardial perfusion defects are key predictors.
- Early identification of high-risk patients may guide timely intervention.
Abstract:
We determined the incidence and clinical, noninvasive, and angiographic variables contributing to postdischarge early (< or = 3 months) and late (> 3 months) congestive heart failure (CHF) after anterior wall acute myocardial infarction. The patient cohort consisted of 94 consecutive patients < 65 years of age who underwent predischarge exercise thallium-201 planar scintigraphy, rest radionuclide angiography, and coronary arteriography. At a mean of 49 months of follow-up, 10 of the 68 medically managed patients developed early CHF, and 10 had late CHF. The 10 patients with early CHF had significantly higher peak creatine kinase values (2,494 vs 1,032 IU/L, p = 0.01), and at discharge, a lower left ventricular (LV) ejection fraction (28 +/- 11% vs 41 +/- 11%, p < 0.02), more persistent thallium-201 defects (3.4 +/- 1.2 vs 2.1 +/- 1.2, p < 0.02), and fewer stress-induced redistribution defects (1.4 +/- 1.1 vs 0.4 +/- 1.1, p < or = 0.05) than those with late CHF. The early group had less multivessel disease (40% vs 90%, p < or = 0.03). Fifty percent (5 of 10) of patients who developed late CHF did so after a recurrent infarction compared with 10% (1 of 10) in the early CHF group (p < 0.07) and 8% in the group without CHF (p < 0.003). The 26 patients who underwent bypass surgery within 3 months had an LV ejection fraction and extent of ischemia and extent of angiographic stenoses comparable to patients with late CHF. None required hospitalization for CHF or had sustained a recurrent infarction.(ABSTRACT TRUNCATED AT 250 WORDS)