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European Heart Journal 1992 13(1):39-44;
Copyright © 1992 by the European Society of Cardiology.
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© 1992 The European Society of Cardiology

Left ventricular aneurysm and prognosis in patients with first acute transmural anterior myocardial infarction and isolated left anterior descending artery disease

W. F. SHEN, C. TRIBOUILLOY, A. MIRODE, H. DUFOSSÉ and J. P. LESBRE

The Department of Cardiology, South Hospital. University of Picardie 80000 Amiens Cédex, France

Received 2 July 1990; revised 15 February 1991; .

Correcpondence Jean-Philippe Lesbre. MD. Professor of Medecine, Service de Cardiologie B. Höpital Sud, CHRU. 80054 Amiens Cedex, France

Abstract

To determine the clinical and angiographic factors responsible for left ventricular aneurysm formation and the prognosis of patients with aneurysm, 79 patients with a first acute transmural anterior myocardial infarction and angiographically documented isolated left anterior descending artery disease were retrospectively evaluated. Presence of large infarct size and left ventricular volumes, reduced left ventricular function, and evidence of clinical functional impairment were more common in patients with aneurysm (n = 31) than in those without (n = 48). Patients with aneurysm often had total occlusion of the proximal left anterior descending artery without collateral vessels on angiography. During a mean follow- up of 53 months, 10 patients with and three without aneurysm died (P <0.01). Compared to survivors with or without aneurysm, the nonsurvivors were older, had significantly larger infarct size and left ventricular volumes and poor systolic function. The incidence of total occlusion of the left anterior descending artery without collaterals was higher in non-survivors. In patients with aneurysm, stepwise multivariate analysis revealed that left ventricular ejection fraction and the status of left anterior descending artery obstruction and collaterals were independent predictors of mortality. The study indicates that in patients with a first acute transmural anterior myocardial infarction and isolated anterior descending artery disease, left ventricular aneurysm often results from a large infarct caused by total occlusion of the proximal left anterior descending artery without collateral supply to the infarct region. The reduced survival rate for patients with aneurysm is primarily related to severe global left ventricular dysfunction which may be determined by assessing the residual flow to the infarct region.

Key Words: Myocardial infarction • aneurysm • prognosis


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