EFFECT OF LATE PERCUTANEOUS ANGIOPLASTIC RECANALIZATION OF TOTAL CORONARY-ARTERY OCCLUSION ON LEFT-VENTRICULAR REMODELING, EJECTION FRACTION, AND REGIONAL WALL-MOTION

The clinical benefit of late recanalization of complete coronary occlu sion is debated. Left ventricular (LV) function and volumes are major prognostic determinants in patients with coronary artery disease. We s ought to assess comprehensively the evolution of global and regional L V function and LV volumes after percutaneous recanalization of chronic complete coronary artery occlusions. A consecutive series of 55 patie nts who underwent successful percutaneous recanalization of a chronic (greater than or equal to 10 days), total (Thrombolysis in Myocardial Infarction trial flow grade 0) occlusion of the left anterior descendi ng or dominant right coronary arteries, and in whom a complete angiogr aphic evaluation was available before angioplasty and at follow-up was studied. At follow-up, 38 patients had a patent artery (group 1) and 17 had ct reocclusion (group 2). Baseline parameters were similar in t he 2 groups. In group 1, LV ejection fraction increased from 55 +/- 14 % to 62 +/- 13% (p < 0.001), with an increase in fractional shortening in the occluded artery territory (0.43 +/- 0.30 to 0.71 +/- 0.34, p < 0.001), while LV end-diastolic volume remained unchanged. In group 2, ejection fraction and regional wall motion were unchanged, while LV e nd-diastolic volume index increased (86 +/- 22 ml/m(2) to 99 +/- 34 ml /m(2), p < 0.02). The evolution in LV global and regional function was similar in patients with or without previous myocardial infarction; h owever, prevention of LV remodeling was observed only in patients with previous infarction. Maintained patency after successful recanalizati on of totally occluded coronary arteries improves global and regional LV function and, in patients with previous myocardial infraction, avoi ds LV remodeling.