COMPARISON OF EARLY INVASIVE AND CONSERVATIVE TREATMENTS IN PATIENTS WITH ANTERIOR WALL NON-Q-WAVE ACUTE MYOCARDIAL-INFARCTION

To compare the long-term prognosis of a group of patients treated by a n early invasive approach after a non-Q-wave anterior wall acute myoca rdial infarction (AMI) with a similar group treated conservatively, da ta from 110 consecutive patients with non-Q-wave AMI were retrospectiv ely obtained from 3 different hospitals: (1) a hospital with coronary angioplasty and coronary bypass facilities favoring an early invasive approach, (2) ct hospital with a catheterization laboratory and no cor onary angioplasty or coronary bypass facilities, and (3) a community h ospital without a catheterization laboratory. Patients were divided ac cording ta the presence or absense of an early invasive approach: thos e who had undergone in-hospital catheterization and revascularization (n = 55) and those with a conservative approach (n = 55). The early in vasive approach resulted in a significant decrease in major events. Th e rate of recurrent myocardial infarction was 29% in the conservative group versus 7.2% in the invasive group (p = 0.025). Survival rate cur ves at 3-year follow-up showed significant differences in mortality (p = 0.001), recurrent myocardial infarction (p = 0.002), recurrent angi na pectoris (p = 0.001), and development of congestive heart failure ( p = 0.05). Multivariate analysis disclosed the early invasive approach to be an independent predictor for decreasing the likelihood of recur rent infarction by 86% (odds ratio 0.14, confidence intervals 0.04 to 0.48 p = 0.0006), and for decreasing the likelihood of recurrent angin a by 66% (odds ratio 0.34, confidence intervals 0.18 to 0.63, p <0.005 ). The early invasive strategy may result in an improved outcome in th e treatment of patients with non-Q-wave anterior wall AMI compared wit h patients treated conservatively.