Copyright © 1998 by the European Society of Cardiology.
Degree of residual stenosis of the infarct-related artery. Another variable affecting recovery of regional function after thrombolysis
a Cardiology, Department of Internal Medicine and Public Health, University of L’Aquila
b Department of Cardiovascular and Respiratory Sciences, ‘La Sapienza’ University, Rome, Italy
accepted October 13, 1997
Aims
The aim of this study was to analyse the relationship between infarct-related artery residual stenosis, assessed by quantitative coronary angiography, and left ventricular function changes during the in-hospital period in patients with acute myocardial infarction undergoing thrombolytic treatment.
Methods and Results
The study population consisted of 90 patients with acute myocardial infarction treated with thrombolysis within 6h of the onset of symptoms. Left ventricular function was serially assessed by an echocardiographic asynergy score (before thrombolysis and pre-discharge). Left ventricular end-diastolic and end-systolic volumes were also calculated. Coronary stenosis was evaluated by computer-assisted videodensitometric analysis at pre-discharge coronary angiography. Three subgroups were identified on the basis of left ventricular function changes: 25 patients (Group A) with regional myocardial improvement (echo score from 7·5±3·5 to 4·3±3·2), 51 (Group B) with no variation in echo score (4·8±2·7) and 14 (Group C) with myo-cardial regional worsening (echo score from 4·4±2·1 to 8·8±2·4). Group A patients exhibited a very high incidence of infarct-related artery patency (23/25 patients, 92%) vs 71% with unchanged (Group B) and 14% (Group C) with worsening regional left ventricular function (P<0·001). Subdivision of the study population on the basis of residual stenosis severity showed that a significant improvement in left ventricular function was present only in the subgroup with residual stenosis <75% (echo score from 5·2±3·4 to 3·6±2·9,P<0·001).
Conclusion
These results support the important role exerted by complete coronary patency after thrombolysis in inducing left ventricular function recovery, and the poor functional improvement in patients with incomplete coronary patency.
Key Words: Coronary patency • acute myocardial infarction • left ventricular function • quantitative coronary angiography
f1 Correspondence: Prof. Maria Penco, Dipartimento di Medicina Interna e Sanita’ Pubblica, Universita’ de L’Aquila, Via S. Sisto 22, 67100 L’Aquila, Italy.
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