SIGNIFICANCE OF LOCATION (ANTERIOR VERSUS INFERIOR) AND TYPE (Q-WAVE VERSUS NON-Q-WAVE) OF ACUTE MYOCARDIAL-INFARCTION IN PATIENTS UNDERGOING PERCUTANEOUS TRANSLUMINAL CORONARY ANGIOPLASTY FOR POSTINFARCTION ISCHEMIA

Predictors of increased risk for recurrent cardiac events and death af ter acute myocardial infarction include postinfarction myocardial isch emia, anterior location of the infarct, and non-Q-wave versus Q-wave i nfarction. Although coronary angioplasty is performed in patients with postinfarction ischemia to alleviate symptoms, the outcome according to location and type of infarction and the effect on prevention of sub sequent myocardial infarction and death are not known. To determine if location and type of myocardial infarction provide prognostic informa tion in patients with postinfarction ischemia, we analyzed morbidity a nd mortality during and after coronary angioplasty according to the lo cation (anterior vs inferior) and type (Q-wave vs non-Q-wave) of myoca rdial infarction in 505 consecutive patients. The incidence of recurre nt angina, repeat coronary angioplasty, coronary bypass surgery, reinf arction, and death during long-term follow-vp after hospital discharge (mean 34 +/- 19 months) for the 440 patients with an initial successf ul angioplasty was also compared. During the procedure, there was no d ifference in the primary success rate or mortality among the different groups; however, more patients with anterior non-Q-wave myocardial in farction underwent emergent bypass grafting after unsuccessful coronar y angioplasty (p = 0.001). Multivariate Cox proportional-hazards analy ses controlling for age, gender, number of diseased vessels, location, type of infarction, and year of coronary angioplasty revealed that mo re patients with anterior infarction had greater than or equal to 1 ca rdiac event (repeat angioplasty, coronary artery bypass grafting, rein farction, or death) than did those with inferior infarction (RR 1.80, 95% confidence interval [CI] 1.22 to 2.65, p = 0.003). The rate of rei nfarction or death was 1.93 times higher in patients with anterior tha n inferior infarction (95% CI 0.97 to 3.82, p = 0.057). There was no d ifference in these cardiac events for Q-wcrve versus non-Q-wave infarc tion (RR 1.15, 95% CI 0.78 to 1.69, p = 0.47). These results suggest t hat anterior location, but not type, of infarction was associated with a greater likelihood of a cardiac event at follow-up.