LEFT-VENTRICULAR FUNCTION AND SECONDARY A NGIOPLASTY AFTER ANTERIOR MYOCARDIAL-INFARCTION IN SINGLE-VESSEL DISEASE

Arterial patency is a good prognostic factor in terms of survival and left ventricular function after myocardial infarction. The aim of this prospective study was to evaluate the benefit of secondary angioplast y of the infarct-related artery in single vessel, left anterior descen ding disease, on regional and global left ventricular function. Initia l coronary angiography was undertaken at the 7th +/- 2 days after the onset of infarction. Arterial patency was assessed by the TIMI criteri a and by percentage stenosis on quantitative angiography. Forty consec utive patients (Group I) underwent conventional angioplasty of the lef t anterior descending artery at the 9th +/- 2 days. Twelve consecutive patients (Group II) did not undergo angioplasty. A repeat coronary an giographic study was performed at 3 months. The results showed no diff erence between the two groups of patients in base line values. A signi ficant improvement in arterial patency was observed in Group I (TIMI G rades II or III) and in residual stenosis at 3 months (54.7 +/- 13 % v ersus 80.6 +/- 13 %, p < 0.05). In addition, a significant improvement in ejection fraction of +4.7 % (p < 0.02), of left anterior descendin g myocardial regional wall motion of + 7.6 (p < 0.02) and a reduction of induced left ventricular end systolic volume of -2.2 ml/m2 (p < 0.0 5) were observed in Group I. Initial segmental hypokinesia or akinesia improved in 67.5 % of patients. However, 50 % of patients in Group II improved their segmental wall motion abnormalities at 3 months. These improvements were more impressive in cases with proximal left anterio r descending artery stenosis (p < 0.04) and in cases with greater-than -or-equal-to 90 % stenosis (p < 0.05). The restenosis rate was 57.5 %. Nevertheless, the restenosis did not change the improvement in region al and global left ventricular function. No significant improvement wa s noted in Group H for parameters of regional and global left ventricu lar function. The authors conclude that secondary angioplasty of the c ulprit artery improves global and regional left ventricular function i n patients with single vessel disease after anterior myocardial infarc tion by improving the arterial patency. Proximal and > 90 % stenoses o f the left anterior descending artery seem to derive the greatest bene fit from this procedure.