DELAYED ANGIOPLASTY OF RESIDUAL CORONARY STENOSIS AFTER THROMBOLYSIS FOR MYOCARDIAL-INFARCTION - PROGNOSTIC FACTORS OF LEFT-VENTRICULAR FUNCTION

The aim of this study was to analyse the prognostic factors of long te rm left ventricular function after successful delayed angioplasty of r esidual coronary stenosis after thrombolysis for myocardial infarction . The left ventricular function of fifty patients, aged 54 +/- 10 year s, who underwent intravenous thrombolysis 2.9 +/- 1.3 hours after the onset of myocardial infarction (28 anterior, 22 inferior wall) was ass essed by angiography at the 6.1 +/- 1.7 th day and 6.1 +/- 2.5 months after successful angioplasty undertaken on the 8.3 +/- 5.2nd day. In c ases without reocclusion (n = 44), the ejection fraction and the wall motion of the infarcted region improved significantly from 56.8 +/- 12 .2% to 59.5 +/- 15.4% (p < 0.002) and from 8.4 +/- 14.8% to 18.3 +/- 2 4.3% (p = 0.0001), respectively. These parameters did not change in ca ses with reocclusion (n = 6). When the dilated artery remained patent, an improvement in motion of the infarcted region was observed in 69.5 % of hypokinesis (n = 23), 50% of akinesis (n = 10) and 9.1% of dyskin esis (n = 11) (p < 0.005). The improvement in motion of the infarcted zone was negatively correlated with the delay of thrombolysis (r = 0.3 6; p < 0.02) and peak CPK levels (r = 0.31; p < 0.04). Over 60% resten osis on digitalised densitometry (n = II) did not compromise the possi bilities of improvement, the evolution of wall motion of the infarcted zone and volumes with respect to cases without restenosis (n = 33). I n the absence of reocclusion, left ventricular remodelling was not aff ected by the percentage stenosis at control angiography (47 +/- 26% vs 46 +/- 22%; p = NS) but was mainly dependant on the severity of left ventricular dysfunction observed at the 6th day. The increase in end d iastolic volume was greater in cases with initial left ventricular eje ction fractions of less than 50% (+23.7 +/- 29.9% vs -3 +/- 12.2%; p < 0.0001), with anterior infarcts (+10.4 +/- 25.3% vs -5.1 +/- 9.4% p < 0.02), and in cases without secondary improvement of wall motion of t he infarcted zone (+12.3 +/- 26.1% vs -4.9 +/- 9.7%; p < 0.006). Contr ary to reocclusion, restenosis did not seem to be an obstacle to sympt omatic recovery. In addition to arterial patency, the chances of impro vement seem to depend on the severity of wall motion abnormalities obs erved on the 6 th day.