EFFECT OF DELAYED PERCUTANEOUS TRANSLUMINAL CORONARY ANGIOPLASTY OF OCCLUDED CORONARY-ARTERIES AFTER ACUTE MYOCARDIAL-INFARCTION

Whether angioplasty of occluded vessels after myocardial infarction ma y have beneficial effects on left ventricular function remains unknown . Patients with a first myocardial infarction and thrombolytic therapy who had an occluded infarct-related vessel at delayed coronary angiog raphy were referred systematically for an elective coronary angioplast y performed between 3 and 4 weeks after the myocardial infarction. All patients underwent stress-redistribution-reinjection thallium-201 sin gle-photon emission computed tomography for myocardial viability asses sment. Prior angioplasty, ct quantitative evaluation of global and reg ional left ventricular function, was performed. The study group consis ted of 38 patients (aged 57 +/- 10 years); 18 had anterior wall infarc tions and 20 inferior wall infarctions, but before angioplasty 3 had a patent artery and were excluded. Angioplasty was successful in 30 pat ients. At follow-vp 13 patients (43%) had an occluded coronary artery. In contrast with patients with an occluded coronary artery at follow- vp, those with a patent coronary artery had no left ventricular enlarg ement and had an improvement in both left ventricular ejection fractio n (from 48 +/- 9% to 52 +/- 9.8%, p = 0.002) and regional wall motion index (Delta = +0.95 SD, p < 0.01). In patients with a patent vessel a t follow-up, there was a positive correlation between the number of my ocardial viable segments and improvement of the infarct zone wall moti on (r = 0.52; p = 0.035), and the number of necrotic segments at basel ine was positively correlated to the 4-month changes in end-diastolic volume indexes (r = 0.6; p = 0.04). Thus, elective revascularization o f occluded coronary arteries with viable myocardium after myocardial i nfarction improves left ventricular function and lessens remodeling if the artery remains patent during follow-up.