RECANALIZATION OF CHRONICALLY OCCLUDED IN FARCT VESSEL IN SINGLE-VESSEL CORONARY-ARTERY DISEASE - REDUCTION OF CARDIAC EVENTS DURING LONG-TERM FOLLOW-UP

Objective: The prognostic significance of recanalisation of a chronica lly occluded infarct vessel in single-vessel coronary disease remains controversial, in contrast to early re-opening of the infarct vessel i n the acute state of infarction. It was the purpose of this prospectiv e study to discover whether successful recanalisation in the former in fluences the incidence of cardiac events (death, infarction, by-pass o peration) and clinical symptoms in the long term. Patients and method: Recanalisation procedures were successful in 58, unsuccessful in 41 o f 99 patients (81 men, 18 women; mean age 55 [28-79] years) with anter ior wall (n = 53) or posterior wall (n = 46) myocardial infarction (AM I and PMI, respectively). The two groups were similar with respect to age, sex, left-ventricular function, indication, exercise capacity and premedication. But the interval between infarction and recanalisation was shorter in the patients who had successful recanalisation (5.1 +/ - 5.3 vs 7.8 +/- 7.6 months; P < 0.05). Mean follow-up period for all patients was 55.8 +/- 8.9 months after the recanalisation procedure. R esults: There were significantly fewer cardiac events after successful than failed recanalisation, both for the total group of patients (5% vs 23%; P < 0.01) and those with AMI (9 vs 36%; P = 0.012). In the pat ients with PMI there was only a trend in favour of those with successf ul recanalisation (0% vs 14%; P = 0.058). Symptomatic improvement was reported by 73% of patients after successful but only 40% after failed recanalisation (P < 0.01). Conclusion: The results provide pointers t owards prognostic indications of recanalisation even after chronic occ lusion of the infarct vessel. The procedure should therefore be attemp ted if the occlusion is morphologically suitable.