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Long-term implications of reocclusion on left ventricular size and function after successful thrombolysis for first
F Nijland1, O Kamp, F W Verheugt
1Department of Cardiology, Research School Free University Hospital, Amsterdam, Netherlands. cardiol@azvu.nl
Insights
Reocclusion after heart attack treatment harms long-term heart function. Patients with reocclusion experienced significant left ventricular dilatation and poorer functional recovery 5 years post-myocardial infarction.
Area of Science:
- Cardiology
- Cardiovascular Research
- Interventional Cardiology
Background:
- Successful thrombolysis is crucial for preventing left ventricular dilatation post-acute myocardial infarction.
- Reocclusion of the infarct-related artery occurs in approximately 30% of patients despite initial successful treatment.
- Long-term consequences of reocclusion on left ventricular remodeling and function remain a critical area of investigation.
Purpose of the Study:
- To evaluate the long-term effects of infarct-related artery reocclusion on left ventricular size and function.
- To identify predictors of left ventricular dilatation after myocardial infarction.
- To assess functional recovery of the left ventricle in patients with and without reocclusion.
Main Methods:
- Two-dimensional echocardiography was used to assess left ventricular volumes and function.
- Patients (n=56) were studied at baseline (2 days) and 5 years post-first anterior myocardial infarction.
- Coronary angiography at 3 months identified patients with patent infarct-related arteries versus those with reocclusion.
Main Results:
- Patients with reocclusion showed significant increases in end-diastolic volume index (EDVI) and end-systolic volume index (ESVI) over 5 years.
- Reocclusion was associated with impaired improvement in wall motion score index (WMSI) and ejection fraction (EF).
- Multivariate analysis identified baseline WMSI and reocclusion as independent predictors of left ventricular dilatation.
Conclusions:
- Reocclusion within 3 months of thrombolysis is linked to significant left ventricular dilatation.
- Reocclusion detrimentally impacts the functional recovery of the left ventricle 5 years after myocardial infarction.
- Early identification and management of reocclusion are vital for improving long-term outcomes after acute myocardial infarction.
Background:
Successful thrombolysis can prevent left ventricular dilatation after acute myocardial infarction. However, in almost 30% of patients, reocclusion occurs. The aim of this study was to assess the long-term implications of reocclusion on left ventricular size and function.
Methods And Results:
Fifty-six patients were studied with two-dimensional echocardiography at baseline (2 +/- 1.6 days) and 5.0 +/- 1.4 years after first anterior myocardial infarction. All patients (a subset of those enrolled in the APRICOT trial) had a patent infarct-related artery when studied < 48 hours after thrombolysis and underwent repeat coronary angiography at 3 months. Baseline characteristics were comparable in patients with (n = 17) and without reocclusion (n = 39). Left ventricular volume indexes were stable in patients without reocclusion. Patients with reocclusion, however, showed a significant increase in end-diastolic volume index (EDVI; P = .008) and end-systolic volume index (ESVI; P = .039). Furthermore, patients without reocclusion demonstrated improvement in wall motion score index (WMSI; P = .0001) and ejection fraction (EF; P = .016), whereas patients with reocclusion did not. After 5 years, patients with reocclusion had significantly larger volume indexes (EDVI, 99 +/- 41 versus 76 +/- 22 mL/m2, P = .007; ESVI, 59 +/- 40 versus 39 +/- 20 mL/m2, P = .017) and more compromised left ventricular function (WMSI, 1.63 +/- 0.33 versus 1.39 +/- 0.32, P = .013; EF, 45 +/- 13% versus 51 +/- 11%, P = .077) than patients without reocclusion. Multivariate analysis identified baseline WMSI and reocclusion as significant independent predictors of left ventricular dilatation.
Conclusions:
Reocclusion of the infarct-related artery within 3 months of successful thrombolysis is associated with left ventricular dilatation and is detrimental to functional recovery of left ventricular function 5 years after first anterior myocardial infarction.