Clinical outcome of patients with an uncomplicated myocardial infarction: effect of revascularization
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M Claeys1, C J Vrints, J Bosmans
1Department of Cardiology, University Hospital Antwerp, University of Antwerp (U.I.A.), Edegem, Belgium.
Insights
Early revascularization after myocardial infarction (MI) may improve outcomes, especially in high-risk patients. Hypercholesterolemia is a key predictor of major cardiac events (MACE).
Area of Science:
- Cardiology
- Interventional Cardiology
- Nuclear Cardiology
Background:
- Uncomplicated myocardial infarction (MI) requires understanding long-term outcomes.
- Assessing major cardiac events (MACE) is crucial for patient management.
- Coronary artery disease (CAD) extent and treatment strategies influence prognosis.
Purpose of the Study:
- To prospectively assess major cardiac events (MACE) after myocardial infarction (MI).
- To correlate MACE rates with clinical, angiographic, and scintigraphic findings.
- To evaluate the impact of early revascularization on clinical outcomes in MI patients.
Main Methods:
- Prospective assessment of 80 patients with uncomplicated MI over 17 months.
- Adenosine Tc-99m sestamibi SPECT imaging for scintigraphic evaluation.
- Analysis of clinical, angiographic data, and revascularization decisions (angioplasty/surgery).
Main Results:
- Overall MACE rate was 24%, with 4% cardiac death and 5% MI.
- Early revascularization showed a trend towards better outcomes, especially in patients with significant stenosis (MACE 24% vs. 47%).
- Hypercholesterolemia (> 240 mg%) was the sole independent predictor of MACE, increasing risk over fourfold.
Conclusions:
- Elective, early revascularization guided by angiography can favorably alter the natural history of MI.
- Hypercholesterolemia significantly worsens clinical outcomes in patients post-MI.
- Adenosine Tc-99m sestamibi SPECT imaging provides valuable prognostic information.
Abstract:
In 80 patients (pts) with an uncomplicated myocardial infarction (MI) the rate of major cardiac events (MACE) including cardiac death, non-fatal myocardial infarction and recurrent ischemia requiring hospitalization was prospectively assessed over a mean follow-up period of 17 +/- 9 months and related to clinical, angiographic and scintigraphic findings, the latter obtained from adenosine Tc-99m sestamibi SPECT imaging. Decision for revascularization was mainly based on angiographic data and was carried out in a total of 50 patients (angioplasty in 34 pts and cardiac surgery in 16 pts). The overall MACE rate was 24% with a mortality and myocardial infarction rate of 4% and 5%, respectively. Early (< 2 months) revascularization seemed to have a beneficial effect on clinical outcome as was suggested by the following findings: 1) Cardiac events (MACE) were not significantly different in patients with versus without revascularization (MACE 24% versus 23%) although the former constituted a subgroup at higher risk for ischemic events because of a more extensive coronary artery disease state. 2) In the subset of patients with at least one significant coronary artery stenosis the clinical outcome was significantly better in those who were revascularized than in those who underwent no revascularization (MACE 24% vs 47%, p < 0.05. Among a variety of factors, including the scintigraphic and angiographic extent of coronary artery disease and post-MI treatment strategy, multivariate analysis selected hypercholesterolemia (> 240 mg%) as the only independent predictor of MACE with a more than fourfold increase in risk for development of MACE. These data suggest that the natural history, especially the rate of recurrent ischemic events, can be favourably changed by an elective and early revascularization, strategically oriented by the results of the angio-graphic study. Furthermore, our data emphasized the deleterious role of hypercholesterolemia on clinical outcome in patients with a recent MI.