CORONARY ANATOMY AND PROGNOSIS OF YOUNG, ASYMPTOMATIC SURVIVORS OF MYOCARDIAL-INFARCTION

Purpose: To assess the coronary anatomy and prognosis of young, asympt omatic survivors of myocardial infarction. Patients and methods: The r ecords of all 5,316 patients who underwent cardiac catheterization at Parkland Memorial Hospital from July 1978 to December 1992 were review ed to identify those patients 40 years old and younger who were cathet erized within 60 days of a first myocardial infarction. Of 129 such pa tients, 48 had no indication for catheterization other than age (group I), and 81 were catheterized for spontaneous or provocable ischemia ( group II). Extent were examined to ascertain the utility of cardiac ca theterization in the asymptomatic patients. Results: The 2 groups were similar with respect to clinical variables. The asymptomatic survivor s of infarction (group II) (1.0 +/- 0.7 versus 1.5 +/- 1.0 [mean +/- S D] diseased coronary arteries, respectively; P = 0.002) and were less likely to have left-main or 3-vessel coronary artery disease (4% versu s 20%, respectively; P = 0.027). Eighty-three percent of the group I p atients had one diseased coronary artery, or less, and no patient unde rwent angioplasty or coronary bypass grafting on the basis of catheter ization. After 71 +/- 44 months of follow-up, only 5 (10%) had died of a coronary-related event. Conclusions: Asymptomatic survivors of myoc ardial infarction who are 40 years of age or less rarely have left-mai n or 3-vessel coronary artery disease, and their long-term prognosis w ith conservative therapy is good. Routine catheterization in these pat ients is not warranted and should be reserved for those who manifest s pontaneous or provocable post-infarction ischemia.